Provider Demographics
NPI:1457764995
Name:MEDINA, EILEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:
Last Name:MEDINA
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 1:1641 SHERWOOD VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3119
Mailing Address - Country:US
Mailing Address - Phone:714-746-2237
Mailing Address - Fax:
Practice Address - Street 1:1641 SHERWOOD VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3119
Practice Address - Country:US
Practice Address - Phone:714-746-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist