Active NPI
Renee L. Dolberry, MS, M.ED, CCC-SLP
- Speech-Language Pathologist
- Compton, CA
National Provider Identifier
1902451362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP28612
- Practice address
- 555 W Compton Blvd Ste 106
Compton, CA 90220-3085 - Phone
- (310) 637-1010
- NPI assigned
- Aug 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP28612 | CA | Primary |
Addresses
Primary practice location
555 W Compton Blvd Ste 106
Compton, CA 90220-3085
Mailing address
PO Box 91301
Los Angeles, CA 90009-1301
Phone (310) 480-4916
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SP28612 | Other | CA | STATE OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS |
| 00668004 | Other | AMERICAN SPEECH & HEARING ASSOCIATION |
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
- Credentials
- Master of Education, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP28612 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564704000000",
"number": "1902451362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 91301",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900091301",
"telephone_number": "310-480-4916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 W COMPTON BLVD STE 106",
"city": "COMPTON",
"state": "CA",
"postal_code": "902203085",
"telephone_number": "310-637-1010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLBERRY",
"first_name": "RENEE",
"middle_name": "L.",
"name_prefix": "Ms.",
"credential": "MS, M.ED, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-02",
"last_updated": "2019-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP28612",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS",
"identifier": "SP28612",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN SPEECH & HEARING ASSOCIATION",
"identifier": "00668004",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Compton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.