Provider Demographics
NPI:1609405166
Name:GREEN, MERCEADES QUINNIECE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERCEADES
Middle Name:QUINNIECE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MERCEADES
Other - Middle Name:QUINNIECE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1798 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2918
Mailing Address - Country:US
Mailing Address - Phone:909-865-9500
Mailing Address - Fax:
Practice Address - Street 1:1601 MONTE VISTA AVE STE 230
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6606
Practice Address - Country:US
Practice Address - Phone:909-621-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP29185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist