Provider Demographics
NPI:1730595794
Name:GREEN, SARELLE (SLP)
Entity type:Individual
Prefix:
First Name:SARELLE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:SLP
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 674
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0674
Mailing Address - Country:US
Mailing Address - Phone:818-970-7927
Mailing Address - Fax:818-222-9972
Practice Address - Street 1:4245 PARK ALISAL
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1781
Practice Address - Country:US
Practice Address - Phone:818-970-7927
Practice Address - Fax:818-222-9972
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP1718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist