Provider Demographics
NPI:1972109783
Name:PRICE, DMANDA
Entity Type:Individual
Prefix:
First Name:DMANDA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 ELBERON AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1324
Mailing Address - Country:US
Mailing Address - Phone:973-356-7010
Mailing Address - Fax:
Practice Address - Street 1:20820 EARL ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4307
Practice Address - Country:US
Practice Address - Phone:310-371-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30604235Z00000X
TX116143235Z00000X
NJ41YS01054700235Z00000X
14144646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty