Provider Demographics
NPI:1639567548
Name:SANTOS, JOHN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SOUTH NORFOLK ST.
Mailing Address - Street 2:#205
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:510-289-3965
Mailing Address - Fax:
Practice Address - Street 1:401 S NORFOLK ST
Practice Address - Street 2:#205
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3074
Practice Address - Country:US
Practice Address - Phone:510-289-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist