Provider Demographics
NPI:1043620784
Name:TREVINO, JOSHUA (SLP-A)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N CEDAR ST
Mailing Address - Street 2:102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4453
Mailing Address - Country:US
Mailing Address - Phone:626-616-0100
Mailing Address - Fax:
Practice Address - Street 1:113 N CEDAR ST
Practice Address - Street 2:102
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4453
Practice Address - Country:US
Practice Address - Phone:626-616-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-03
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26312355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant