Provider Demographics
NPI:1376809749
Name:EKEDAL, MARIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:EKEDAL
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 1:256 PALM VALLEY BLVD
Mailing Address - Street 2:APT 209
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1040
Mailing Address - Country:US
Mailing Address - Phone:858-229-6743
Mailing Address - Fax:
Practice Address - Street 1:17400 MONTEREY RD STE 2B
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7319
Practice Address - Country:US
Practice Address - Phone:858-229-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist