Individual provider Active NPI

Laura Agyeman, LICENSE, CCC-SLP

  • Speech-Language Pathologist
  • San Diego, CA
National Provider Identifier
1902383995
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
23714 Issued in CA
Practice address
13223 Black Mountain Rd # 1358
San Diego, CA 92129-2698
Phone
(858) 753-5082
NPI assigned
Jul 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 23714 CA Primary

Addresses

Primary practice location

13223 Black Mountain Rd # 1358
San Diego, CA 92129-2698

Mailing address

13223 Black Mountain Rd # 1358
San Diego, CA 92129-2698
Phone (858) 256-6231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Radiant Speech Therapy, Inc. Speech-Language Pathologist CurrentSince Sep 29, 2019 Accepting new patients

Locations

13223 Black Mountain Rd
#1358
San Diego, CA 92129
Phone (858) 603-7627

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1902383995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13223 BLACK MOUNTAIN RD # 1358",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292698",
            "telephone_number": "858-256-6231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13223 BLACK MOUNTAIN RD # 1358",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921292698",
            "telephone_number": "858-753-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGYEMAN",
        "first_name": "LAURA",
        "credential": "LICENSE, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-23",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "23714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.