Organization
APPLIED INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN WOLLAM (SPEECH-LANGUAGE PATHOLOGIST)
(707) 954-8631
Entity
Organization
Contact information
Practice address
550 E WASHINGTON BLVD, SUITE 200 BOX 8, CRESCENT CITY, CA 95531-8160
(707) 354-8631
Mailing address
245 N ROSSINI LN, SMITH RIVER, CA 95567-9503
(707) 954-8631
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11534
CA
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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