Healthcare Provider Details

I. General information

NPI: 1235786252
Provider Name (Legal Business Name): SHEA NICOLE COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N VICTORIA AVE
VENTURA CA
93003-2344
US

IV. Provider business mailing address

11065 CREEK RD
OJAI CA
93023-9411
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-7971
  • Fax:
Mailing address:
  • Phone: 570-490-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: