Provider Demographics
NPI:1083208045
Name:DOMALAOG, EILEEN MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:DOMALAOG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E ROMIE LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4026
Mailing Address - Country:US
Mailing Address - Phone:831-998-7554
Mailing Address - Fax:831-273-1796
Practice Address - Street 1:535 E ROMIE LN STE 1
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:831-998-7554
Practice Address - Fax:831-273-1796
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist