Doctor Name: | STACY RAVNIKAR |
NPI Number: | 1770926057 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 16588 |
Business Practice Address: | 16052 Beach Blvd Ste 135 Huntington Beach, CA - 926473817 |
Business Phone Number: | 7149160641 |
Business Fax Number: | |
Mailing Address: | 3605 E Anaheim St Unit 103, LONG BEACH |
State: | CA |
Postal Code: | 908046418 |
Phone Number: | 7145833891 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2013 |
NPI Last Update Date: | 04/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 16588 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |