Provider Demographics
NPI:1730945791
Name:BELGRAVE, MIN SHON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:SHON
Last Name:BELGRAVE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MIN
Other - Middle Name:
Other - Last Name:SHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:825 S MYRTLE AVE UNIT 518
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8624
Mailing Address - Country:US
Mailing Address - Phone:626-646-9747
Mailing Address - Fax:
Practice Address - Street 1:675 YGNACIO VALLEY RD STE B212
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8209
Practice Address - Country:US
Practice Address - Phone:510-250-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist