Provider Demographics
NPI:1679121503
Name:VELARDE-GREENE, MARIYAH (SLPA)
Entity type:Individual
Prefix:
First Name:MARIYAH
Middle Name:
Last Name:VELARDE-GREENE
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 1:100 BICENTENNIAL CIR APT 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2852
Mailing Address - Country:US
Mailing Address - Phone:916-893-3324
Mailing Address - Fax:
Practice Address - Street 1:1261 TRAVIS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4804
Practice Address - Country:US
Practice Address - Phone:707-344-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44402355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant