Healthcare Provider Details

I. General information

NPI: 1386971380
Provider Name (Legal Business Name): JAN ALLYSON SNAVELY MS-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N BREA BLVD
BREA CA
92821-2606
US

IV. Provider business mailing address

4870 CALLE REAL
SANTA BARBARA CA
93111-1903
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-6842
  • Fax:
Mailing address:
  • Phone: 714-317-7984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: