Provider Demographics
NPI:1518128842
Name:PARSONS, AMY MARIA STARLIGHT (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIA STARLIGHT
Last Name:PARSONS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 BROADWAY ST
Mailing Address - Street 2:#4
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3497
Mailing Address - Country:US
Mailing Address - Phone:415-609-3576
Mailing Address - Fax:
Practice Address - Street 1:811 BROADWAY ST
Practice Address - Street 2:#4
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3497
Practice Address - Country:US
Practice Address - Phone:415-609-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist