Provider Demographics
NPI:1902155617
Name:WARD, LETHE (MACCCSP6069)
Entity Type:Individual
Prefix:MRS
First Name:LETHE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MACCCSP6069
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4436
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4436
Mailing Address - Country:US
Mailing Address - Phone:213-804-2516
Mailing Address - Fax:
Practice Address - Street 1:555 W COMPTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3085
Practice Address - Country:US
Practice Address - Phone:310-637-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist