Provider Demographics
NPI:1124395637
Name:PERKINS, NNENNA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:PERKINS
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 1:3336 N TEXAS ST
Mailing Address - Street 2:SUITE J309
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-9762
Mailing Address - Country:US
Mailing Address - Phone:707-718-4162
Mailing Address - Fax:
Practice Address - Street 1:3336 N TEXAS ST
Practice Address - Street 2:SUITE J309
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-9762
Practice Address - Country:US
Practice Address - Phone:707-718-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist