Provider Demographics
NPI:1740693332
Name:SHIMONI, MIRIAM HANNA (MS SLP-CFY)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:HANNA
Last Name:SHIMONI
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 W. CLINTON AVE, 90048
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:818-943-5116
Mailing Address - Fax:
Practice Address - Street 1:8360 W. CLINTON AVE
Practice Address - Street 2:APARTMENT 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:818-943-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist