Provider Demographics
NPI:1538679105
Name:DEAN, DAVID LAMAR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LAMAR
Last Name:DEAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SHELBY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5556
Mailing Address - Country:US
Mailing Address - Phone:843-754-0124
Mailing Address - Fax:909-781-2445
Practice Address - Street 1:3350 SHELBY ST STE 200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5556
Practice Address - Country:US
Practice Address - Phone:843-754-0124
Practice Address - Fax:909-781-2445
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist