Provider Demographics
NPI:1275891558
Name:JOHN, JEEVA (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JEEVA
Middle Name:
Last Name:JOHN
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 1:10897 MCPEAK LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-5543
Mailing Address - Country:US
Mailing Address - Phone:925-285-4498
Mailing Address - Fax:
Practice Address - Street 1:7567 AMADOR VALLEY BLVD
Practice Address - Street 2:#101
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2441
Practice Address - Country:US
Practice Address - Phone:925-829-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist