Provider Demographics
NPI:1801268768
Name:LY, XUAN (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:XUAN
Middle Name:
Last Name:LY
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23901 CIVIC CENTER WAY APT 131
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4884
Mailing Address - Country:US
Mailing Address - Phone:310-874-9854
Mailing Address - Fax:
Practice Address - Street 1:23901 CIVIC CENTER WAY APT 131
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4884
Practice Address - Country:US
Practice Address - Phone:310-874-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 23028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist