Provider Demographics
NPI:1598077653
Name:PENDLETON, JEWEL ANN (SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:JEWEL
Middle Name:ANN
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24552 PASEO DE VALENCIA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4236
Mailing Address - Country:US
Mailing Address - Phone:949-458-0683
Mailing Address - Fax:949-458-0680
Practice Address - Street 1:24552 PASEO DE VALENCIA
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4236
Practice Address - Country:US
Practice Address - Phone:949-458-0683
Practice Address - Fax:949-458-0680
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist