Provider Demographics
NPI:1144091919
Name:NERSISYAN, NARE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NARE
Middle Name:
Last Name:NERSISYAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 GLENCREST DR
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3542
Mailing Address - Country:US
Mailing Address - Phone:818-720-0057
Mailing Address - Fax:
Practice Address - Street 1:8437 GLENCREST DR
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3542
Practice Address - Country:US
Practice Address - Phone:818-720-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist