Provider Demographics
NPI:1154633493
Name:SLANKARD, KAMELIA ROUHANI (SLP)
Entity Type:Individual
Prefix:
First Name:KAMELIA
Middle Name:ROUHANI
Last Name:SLANKARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FASHION LN
Mailing Address - Street 2:SUITE 116
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3325
Mailing Address - Country:US
Mailing Address - Phone:714-368-9396
Mailing Address - Fax:714-368-9396
Practice Address - Street 1:161 FASHION LN
Practice Address - Street 2:SUITE 116
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3325
Practice Address - Country:US
Practice Address - Phone:714-368-9396
Practice Address - Fax:714-368-9396
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist