Provider Demographics
NPI:1124111547
Name:BIRD, JANICE MARIE (MS, CCC, SLP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:BIRD
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-7732
Mailing Address - Country:US
Mailing Address - Phone:916-359-4516
Mailing Address - Fax:916-359-4516
Practice Address - Street 1:2900 JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-7732
Practice Address - Country:US
Practice Address - Phone:916-359-4516
Practice Address - Fax:916-359-4516
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0114760Medicaid