Provider Demographics
NPI:1962743385
Name:PERRY, JOANNA MARIE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12884 RAINTREE CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4665
Mailing Address - Country:US
Mailing Address - Phone:909-856-8897
Mailing Address - Fax:
Practice Address - Street 1:5945 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1800
Practice Address - Country:US
Practice Address - Phone:951-779-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant