Provider Demographics
NPI:1679379242
Name:POWELL, AIMEE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:POWELL
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:RUBENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:13712 VIA CIMA BELLA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2721
Mailing Address - Country:US
Mailing Address - Phone:858-212-2463
Mailing Address - Fax:
Practice Address - Street 1:8996 MIRAMAR RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4463
Practice Address - Country:US
Practice Address - Phone:760-688-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist