Provider Demographics
NPI:1295388619
Name:MORIKAWA, MACY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:MORIKAWA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3459
Mailing Address - Country:US
Mailing Address - Phone:424-269-3400
Mailing Address - Fax:310-882-5451
Practice Address - Street 1:11840 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3459
Practice Address - Country:US
Practice Address - Phone:424-269-3400
Practice Address - Fax:310-882-5451
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13649235Z00000X
CA30197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist