Provider Demographics
NPI:1306383534
Name:PIERRE-LOUIS, FUNDY M (CCC)
Entity Type:Individual
Prefix:
First Name:FUNDY
Middle Name:M
Last Name:PIERRE-LOUIS
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12139 MT VERNON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313
Mailing Address - Country:US
Mailing Address - Phone:909-883-5069
Mailing Address - Fax:
Practice Address - Street 1:12139 MOUNT VERNON AVE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5500
Practice Address - Country:US
Practice Address - Phone:909-883-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist