Basic Information
| Provider Information | |||||||||
| NPI: | 1518175140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MS CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2918 N KEYSTONE ST | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188465391 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5601 DE SOTO AVE | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913676701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187192930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP15564 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.