Provider Demographics
NPI:1508246810
Name:IRWIN, JUSTINE (SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 OSIO WAY
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5510
Mailing Address - Country:US
Mailing Address - Phone:831-869-2188
Mailing Address - Fax:
Practice Address - Street 1:8 OSIO WAY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5510
Practice Address - Country:US
Practice Address - Phone:831-869-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist