1578697959 NPI number — INNOVATIVE SPEECH THERAPY ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578697959 NPI number — INNOVATIVE SPEECH THERAPY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SPEECH THERAPY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INNOVATIVE THERAPY ASSOCIATES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578697959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13400 RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-783-5168
Provider Business Mailing Address Fax Number:
818-783-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13400 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-783-5168
Provider Business Practice Location Address Fax Number:
818-783-6176
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MIDDLETON
Authorized Official First Name:
RIK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
818-783-5168

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP6646 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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