Provider Demographics
NPI:1780238840
Name:DEAN, LILLIAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:DEAN
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 1:943 CASANOVA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6806
Mailing Address - Country:US
Mailing Address - Phone:802-324-1862
Mailing Address - Fax:
Practice Address - Street 1:787 MUNRAS AVE STE 101
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3131
Practice Address - Country:US
Practice Address - Phone:831-645-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT12129334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist