Provider Demographics
NPI:1134794720
Name:JOEL, KAMERAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAMERAN
Middle Name:
Last Name:JOEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26356 VINTAGE WOODS RD APT 16O
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7212
Mailing Address - Country:US
Mailing Address - Phone:541-647-7718
Mailing Address - Fax:
Practice Address - Street 1:980 ROOSEVELT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3672
Practice Address - Country:US
Practice Address - Phone:949-333-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist