Provider Demographics
NPI:1992096283
Name:GIFFIN, ADRIANE MUTTI (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:MUTTI
Last Name:GIFFIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 RAVENSPUR DR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3538
Mailing Address - Country:US
Mailing Address - Phone:402-616-8731
Mailing Address - Fax:
Practice Address - Street 1:5718 RAVENSPUR DR UNIT 304
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3538
Practice Address - Country:US
Practice Address - Phone:402-616-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist