Provider Demographics
NPI:1629341300
Name:MANUEL-MOTEN, LORNA RENITA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:RENITA
Last Name:MANUEL-MOTEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W ATHENS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:879 W 190TH ST
Practice Address - Street 2:STE 400
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4223
Practice Address - Country:US
Practice Address - Phone:213-373-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist