Provider Demographics
NPI:1699082362
Name:ABARANOK, ILYSSA T (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ILYSSA
Middle Name:T
Last Name:ABARANOK
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 1:11215 HUSTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5385
Mailing Address - Country:US
Mailing Address - Phone:310-435-7920
Mailing Address - Fax:818-358-3842
Practice Address - Street 1:11215 HUSTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-5385
Practice Address - Country:US
Practice Address - Phone:310-435-7920
Practice Address - Fax:818-358-3842
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist