Provider Demographics
NPI:1225541493
Name:REYNOSO, ANAHI (SLPA)
Entity Type:Individual
Prefix:
First Name:ANAHI
Middle Name:
Last Name:REYNOSO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:JESUS
Other - Middle Name:ANAHI
Other - Last Name:URREA AISPURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:3532 PLATT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3420
Mailing Address - Country:US
Mailing Address - Phone:310-259-9578
Mailing Address - Fax:
Practice Address - Street 1:12411 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2835
Practice Address - Country:US
Practice Address - Phone:562-693-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA23552355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant