Provider Demographics
NPI:1689098618
Name:JARRETT-ETONYE, CODETH ADORA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:CODETH
Middle Name:ADORA
Last Name:JARRETT-ETONYE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:222 S GARDENGLEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3119
Mailing Address - Country:US
Mailing Address - Phone:310-686-9851
Mailing Address - Fax:
Practice Address - Street 1:706 N DIAMOND BAR BLVD STE B2I
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1059
Practice Address - Country:US
Practice Address - Phone:909-396-8900
Practice Address - Fax:909-861-3423
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist