Provider Demographics
NPI:1720402803
Name:NED, CORA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:NED
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 WESTFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3375
Mailing Address - Country:US
Mailing Address - Phone:562-756-7530
Mailing Address - Fax:
Practice Address - Street 1:3900 BIRCH ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2226
Practice Address - Country:US
Practice Address - Phone:949-955-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist