Provider Demographics
NPI:1992186704
Name:MARVIN, JADA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JADA
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14103 WINCHESTER BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1835
Mailing Address - Country:US
Mailing Address - Phone:405-868-5577
Mailing Address - Fax:405-868-5577
Practice Address - Street 1:14103 WINCHESTER BLVD
Practice Address - Street 2:STE F
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1835
Practice Address - Country:US
Practice Address - Phone:408-868-5577
Practice Address - Fax:405-868-5577
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist