Healthcare Provider Details

I. General information

NPI: 1982944492
Provider Name (Legal Business Name): SILVIA MIRTA WASJUTIN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SILVIA WASJUTIN SLP

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MISSION ST
SANTA BARBARA CA
93101-2820
US

IV. Provider business mailing address

5649 W CAMINO CIELO
SANTA BARBARA CA
93105-9706
US

V. Phone/Fax

Practice location:
  • Phone: 805-253-2547
  • Fax:
Mailing address:
  • Phone: 805-692-1806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 9258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: