Provider Demographics
NPI:1205148996
Name:CHOI, JANE SON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:SON
Last Name:CHOI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:217 W CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6549
Mailing Address - Country:US
Mailing Address - Phone:714-776-1231
Mailing Address - Fax:714-776-0802
Practice Address - Street 1:217 W CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6549
Practice Address - Country:US
Practice Address - Phone:714-776-1231
Practice Address - Fax:714-776-0802
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist