Provider Demographics
NPI:1518438399
Name:WAHEEDUDDIN, ANISA (SLPA)
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:WAHEEDUDDIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21862 BELLCROFT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6066
Mailing Address - Country:US
Mailing Address - Phone:949-916-2421
Mailing Address - Fax:
Practice Address - Street 1:33122 VALLE RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4859
Practice Address - Country:US
Practice Address - Phone:949-395-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant