Provider Demographics
NPI:1538577036
Name:JAMES, KATRINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:OGILBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:235 E. 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-334-9001
Mailing Address - Fax:907-868-8657
Practice Address - Street 1:235 E. 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-334-9001
Practice Address - Fax:907-868-8657
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSLPS492235Z00000X
AK492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK492OtherPROFESSIONAL LICENSE
AK1615691Medicaid