Provider Demographics
NPI:1598420127
Name:NELSON, DANETTE ALISA
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:ALISA
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PACIFIC OAKS RD APT 202
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2936
Mailing Address - Country:US
Mailing Address - Phone:925-348-7997
Mailing Address - Fax:
Practice Address - Street 1:225 PACIFIC OAKS RD APT 202
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2936
Practice Address - Country:US
Practice Address - Phone:925-348-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist