Provider Demographics
NPI:1386971380
Name:SNAVELY, JAN ALLYSON (MS-SLP)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:ALLYSON
Last Name:SNAVELY
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 CALLE REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1903
Mailing Address - Country:US
Mailing Address - Phone:714-317-7984
Mailing Address - Fax:
Practice Address - Street 1:875 N BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2606
Practice Address - Country:US
Practice Address - Phone:714-529-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist