Healthcare Provider Details

I. General information

NPI: 1700714078
Provider Name (Legal Business Name): LUCY K BRAZELL M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE BRAZELL M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 TORITO LN
DIAMOND BAR CA
91765-2152
US

IV. Provider business mailing address

522 TORITO LN
DIAMOND BAR CA
91765-2152
US

V. Phone/Fax

Practice location:
  • Phone: 805-791-9722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: