Provider Demographics
NPI:1003547720
Name:TREZISE, MONIQUE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:TREZISE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 CANEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2213
Mailing Address - Country:US
Mailing Address - Phone:562-326-0462
Mailing Address - Fax:
Practice Address - Street 1:2334 CANEHILL AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2213
Practice Address - Country:US
Practice Address - Phone:562-326-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14337643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14337643OtherDEPT OF CA- SPEECH AND HEARING ASSOCIATION
CA14337643OtherASHA -AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION