Provider Demographics
NPI:1235966284
Name:LIU, TING WEN
Entity type:Individual
Prefix:
First Name:TING WEN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24933 WALNUT ST APT 50
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1067
Mailing Address - Country:US
Mailing Address - Phone:805-524-4210
Mailing Address - Fax:
Practice Address - Street 1:250 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015
Practice Address - Country:US
Practice Address - Phone:805-524-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24620OtherSPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AND HEARING BOARD
14062036OtherAMERICAN SPEECH-LANGUAGE & HEARING ASSOCIATION