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Provider Information for 1164947594

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1164947594

Calendar   Last Updated:  2017-08-07
  Certification Date: 


Name Value
NPI 1164947594
Enumeration Date 2017-08-07
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 367 SANTANA HTS UNIT 7039
SAN JOSE, CA 95128-2084
United States

Phone: 847-902-9808 | Fax:
View Map External Link
Primary Practice Address 357 PIERCY RD
SAN JOSE, CA 95138-1403
United States

Phone: 408-692-5197 | Fax: 408-912-2645
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 235Z00000X - Speech-Language Pathologist
No 235Z00000X - Speech-Language Pathologist IL 146.013907