Provider Demographics
NPI:1558608398
Name:MEDINA, BERNADETTE (SLPA)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MEDINA
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 1:861 AUTO CENTER DR. #D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-945-7878
Mailing Address - Fax:661-945-7553
Practice Address - Street 1:19040 SOLEDAD CANYON RD.
Practice Address - Street 2:# 210
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351
Practice Address - Country:US
Practice Address - Phone:661-945-7878
Practice Address - Fax:661-945-7553
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant