Provider Demographics
NPI:1912225699
Name:BARNES, ALIDA CELESTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALIDA
Middle Name:CELESTE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:ALIDA
Other - Middle Name:CELESTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17609 VENTURA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3858
Mailing Address - Country:US
Mailing Address - Phone:818-530-5145
Mailing Address - Fax:818-501-8325
Practice Address - Street 1:17609 VENTURA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3858
Practice Address - Country:US
Practice Address - Phone:818-530-5145
Practice Address - Fax:818-501-8325
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15553OtherSTATE LICENSE