Healthcare Provider Details

I. General information

NPI: 1689098618
Provider Name (Legal Business Name): CODETH ADORA JARRETT-ETONYE MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

222 S GARDENGLEN ST
WEST COVINA CA
91790-3119
US

V. Phone/Fax

Practice location:
  • Phone: 323-241-1000
  • Fax: 213-241-8953
Mailing address:
  • Phone: 310-686-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: