Individual
CI HE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
5601 DEER VALLEY RD, ANTIOCH, CA 94531-8577
(925) 813-6500
Mailing address
5601 DEER VALLEY RD, ANTIOCH, CA 94531-8577
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
07/14/2025
Last updated
07/14/2025
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