Provider Demographics
NPI:1356577316
Name:BANKS, AIESHEA L (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AIESHEA
Middle Name:L
Last Name:BANKS
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 1:8560 VINEYARD AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4349
Mailing Address - Country:US
Mailing Address - Phone:909-945-2700
Mailing Address - Fax:888-876-2701
Practice Address - Street 1:8560 VINEYARD AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4349
Practice Address - Country:US
Practice Address - Phone:909-945-2700
Practice Address - Fax:888-876-2701
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist