Provider Demographics
NPI:1033478193
Name:CONDONG, IRMA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:CONDONG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11152 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3722
Mailing Address - Country:US
Mailing Address - Phone:510-366-0039
Mailing Address - Fax:
Practice Address - Street 1:3521 LOMITA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5039
Practice Address - Country:US
Practice Address - Phone:310-856-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist