Provider Demographics
NPI:1558846279
Name:AREVALO, VANESA GONZALEZ (SLPA)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:GONZALEZ
Last Name:AREVALO
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 1:11479 ALDRICH ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-1938
Mailing Address - Country:US
Mailing Address - Phone:323-434-4648
Mailing Address - Fax:
Practice Address - Street 1:1221 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4642
Practice Address - Country:US
Practice Address - Phone:323-726-8080
Practice Address - Fax:323-726-8081
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant