Individual
MR. DYLAN ROSS EBERHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14837 PEYTON DR, CHINO HILLS, CA 91709-2075
(909) 606-3010
Mailing address
201 W BROADWAY APT 411, ANAHEIM, CA 92805-0002
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
28508
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14321821
ASHA NUMBER
—
01
—
28508
STATE SLP LICENSE
CA
Enumeration date
05/09/2019
Last updated
05/09/2019
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