Provider Demographics
NPI:1548858954
Name:KAO, BRONWYN NOEL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRONWYN
Middle Name:NOEL
Last Name:KAO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:BRONWYN
Other - Middle Name:NOEL
Other - Last Name:FITZSIMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7508 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3427
Mailing Address - Country:US
Mailing Address - Phone:310-985-0775
Mailing Address - Fax:
Practice Address - Street 1:7508 W 90TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3427
Practice Address - Country:US
Practice Address - Phone:310-985-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP18893OtherSPEECH-LANGUAGE PATHOLOGY LICENSE