1699953539 NPI number — THE GIFT OF SPEECH, A PROFESSIONAL SPEECH LANGUAGE PATHOLOGY CORPORATI

Table of content: (NPI 1699953539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699953539 NPI number — THE GIFT OF SPEECH, A PROFESSIONAL SPEECH LANGUAGE PATHOLOGY CORPORATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GIFT OF SPEECH, A PROFESSIONAL SPEECH LANGUAGE PATHOLOGY CORPORATI
Provider Last Name:
Provider First Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1699953539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4719 QUAIL LAKES DR
Provider Second Line Business Mailing Address:
#G240
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95207-5267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-952-2588
Provider Business Mailing Address Fax Number:
209-952-2544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3031 W MARCH LN
Provider Second Line Business Practice Location Address:
SUITE 117 S
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95219-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-952-2588
Provider Business Practice Location Address Fax Number:
209-952-2544
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FERREIRA
Authorized Official First Name:
KARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-952-2588

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  9117 , 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)

  • Identifier: GSP000680 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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