Individual
CARRIE WADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
17842 IRVINE BLVD STE 118, TUSTIN, CA 92780-3243
(949) 903-8229
Mailing address
540 S LEXINGTON PL, ANAHEIM, CA 92805-4935
(714) 586-7475
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
25390
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25390
SLPAB
CA
Enumeration date
11/21/2016
Last updated
07/21/2022
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