Provider Demographics
NPI:1154887735
Name:EVERETT, JIHAN A (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JIHAN
Middle Name:A
Last Name:EVERETT
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 1:685 S NEW HAMPSHIRE AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1384
Mailing Address - Country:US
Mailing Address - Phone:609-471-4186
Mailing Address - Fax:
Practice Address - Street 1:685 S NEW HAMPSHIRE AVE APT 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1384
Practice Address - Country:US
Practice Address - Phone:609-471-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist