Provider Demographics
NPI:1760835755
Name:PAPAGEORGE, DANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:PAPAGEORGE
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 1:830 TORRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3528
Mailing Address - Country:US
Mailing Address - Phone:214-663-5121
Mailing Address - Fax:
Practice Address - Street 1:830 TORRANCE BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3528
Practice Address - Country:US
Practice Address - Phone:310-921-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004860235Z00000X
NY025732-1235Z00000X
CA26268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist