Provider Demographics
NPI:1730512856
Name:KATRACK, RAEMIN MINOO (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:RAEMIN
Middle Name:MINOO
Last Name:KATRACK
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:27240 TURNBERRY LN
Mailing Address - Street 2:STE 240
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1029
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:661-254-7108
Practice Address - Street 1:27240 TURNBERRY LN
Practice Address - Street 2:STE 240
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1029
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:661-254-7108
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27201235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst