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General NPI Number Information
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NPI Number | 1174990014
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Entity Type | Individual
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Provider Name | HAYLIE MEDOFF
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Gender | Female
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1000 PASEO CAMARILLO STE 108
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City | CAMARILLO
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State | CA
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Zip | 93010-0747
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Country | US
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Telephone | 805-504-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1592 CHARTERWOOD CT
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2778
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Country | US
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Telephone | 412-576-6500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA9599
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License Number State | AZ
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