Healthcare Provider Details

I. General information

NPI: 1326712456
Provider Name (Legal Business Name): ASMAHAN MAAYEH MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LINCOLN ST STE A
DIXON CA
95620-3238
US

IV. Provider business mailing address

2355 FAIRFIELD AVE APT 2
FAIRFIELD CA
94533-2067
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-5246
  • Fax:
Mailing address:
  • Phone: 650-922-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: