Provider Demographics
NPI:1629415864
Name:ADAMS, NAOMI L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:L
Last Name:ADAMS
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 1:2405 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1239
Mailing Address - Country:US
Mailing Address - Phone:209-406-0444
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PKWY STE 800
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5856
Practice Address - Country:US
Practice Address - Phone:800-849-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 7262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist