Provider Demographics
NPI:1295721298
Name:NINNEMAN, MARGARET SUE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:SUE
Last Name:NINNEMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:SUE
Other - Last Name:NINNEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:4744 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5895
Mailing Address - Country:US
Mailing Address - Phone:951-680-0821
Mailing Address - Fax:
Practice Address - Street 1:1350 RECHE CANYON RD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9528
Practice Address - Country:US
Practice Address - Phone:909-370-4411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist