Provider Demographics
NPI:1457820359
Name:TULEY, JANELL PEARL (MS CCC-SLP SP 21125)
Entity Type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:PEARL
Last Name:TULEY
Suffix:
Gender:F
Credentials:MS CCC-SLP SP 21125
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41689 ENTERPRISE CIR N STE 118
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5630
Mailing Address - Country:US
Mailing Address - Phone:951-541-0615
Mailing Address - Fax:
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 118
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-541-0615
Practice Address - Fax:951-296-1943
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477789485OtherTYPE 1 NPI
CA1831508019OtherNPI TYPE 1
CA1093034779OtherTYPE 2 NPI