Provider Demographics
NPI:1134683584
Name:BARNES, PHYLLIS JULIE (MA)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JULIE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 N STATE COLLEGE BLVD APT 3042
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5722
Mailing Address - Country:US
Mailing Address - Phone:831-277-7603
Mailing Address - Fax:
Practice Address - Street 1:293 N STATE COLLEGE BLVD APT 3042
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5722
Practice Address - Country:US
Practice Address - Phone:831-277-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist