Provider Demographics
NPI:1689388787
Name:NORIMATSU, TEAGAN
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:
Last Name:NORIMATSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEAGAN
Other - Middle Name:
Other - Last Name:NORIMATSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28338 TUPELO RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7239
Mailing Address - Country:US
Mailing Address - Phone:951-834-6181
Mailing Address - Fax:
Practice Address - Street 1:441 N LAKE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-3314
Practice Address - Country:US
Practice Address - Phone:951-834-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist