Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jonathan M Waller, MACCC-SLP

Individual provider Speech-Language Pathologist · NPI 1104351964

Jonathan M Waller, MACCC-SLP is a Speech-Language Pathologist in Los Angeles, California. Practices as a sole proprietor. Licensed in California and Georgia.

Licensed in
CA, GA
In the registry since
2017
Specialties on file
2

Practice location Address checks out

1100 N State St CT A2E
Los Angeles, CA 90033-5000
Phone: (323) 409-5082
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence SLP010930 (GA)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence 17522 (CA)

Record details

NPI number1104351964
Entity typeIndividual (Type 1)
GenderMale
Credentials MACCC-SLP
Sole proprietorYes
NPI enumeratedApril 28, 2017
Last updated in NPPESAugust 3, 2020
Certification dateAugust 3, 2020

Other providers in Los Angeles