Provider Demographics
NPI:1952864258
Name:WINDEMUTH, LAILA (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:WINDEMUTH
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:LAILA
Other - Middle Name:
Other - Last Name:GRIDLEY; JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL PSYCHOLOGIST
Mailing Address - Street 1:33299 ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4388
Mailing Address - Country:US
Mailing Address - Phone:909-855-8705
Mailing Address - Fax:
Practice Address - Street 1:390 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4763
Practice Address - Country:US
Practice Address - Phone:909-985-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
CA3938103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool