Provider Demographics
NPI:1144593401
Name:NAGAI, JEANETTE (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:NAGAI
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 1:4118 TRAILCREST DR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3002
Mailing Address - Country:US
Mailing Address - Phone:805-529-2230
Mailing Address - Fax:
Practice Address - Street 1:4118 TRAILCREST DR
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3002
Practice Address - Country:US
Practice Address - Phone:805-529-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist