Healthcare Provider Details

I. General information

NPI: 1417263740
Provider Name (Legal Business Name): NAOMI WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KEEWAYDIN DR
SALEM NH
03079-2839
US

IV. Provider business mailing address

6701 E IMPERIAL HIGHWAY
DOWNEY CA
90242
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-2673
  • Fax: 866-420-1055
Mailing address:
  • Phone: 562-401-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7971
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: