Kathleen R. Wollam, M.A., SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

11534 Issued in CA

Practice address

1080 Mason Mall Ste 6B
Crescent City, CA 95531-4335

Phone

(707) 954-8631

NPI assigned

Jun 15, 2009

Last updated

Oct 21, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Applied Intervention

  • Speech-Language Pathologist
  • Crescent City, CA
  • NPI 1134495773
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1457588691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292",
            "city": "FORT DICK",
            "state": "CA",
            "postal_code": "955380292",
            "telephone_number": "707-954-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 MASON MALL STE 6B",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955314335",
            "telephone_number": "707-954-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLAM",
        "first_name": "KATHLEEN",
        "middle_name": "R.",
        "name_prefix": "Mrs.",
        "credential": "M.A., SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "11534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Price Williams III, MD
• Mellissa Kaye Williams
• Rainee Renae Wilson
• Brianna Wishing
• Dusti Wojcik
• Kathryn A Wood, RN, PHD, FNP
• Krystal Rhae Woods
• Naome Michael Lynn Workman, CADCII, ICADC
• Acaja Wright
• Hiedi Wright, RN, FNP

• Speech-Language Pathologist in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.