MEDICARE: RIVER CITY SPEECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1376174813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY SPEECH

Provider Business Mailing Address
First Line	:	3589 HUME ST
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-6286
Country	:	US
Telephone Number	:	916-718-3005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3589 HUME ST
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-6286
Country	:	US
Telephone Number	:	916-718-3005
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS DEVELOPMENT
Name	:	SHANON KERN
Credential	:
Telephone Number	:	916-718-3005

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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Directions to “RIVER CITY SPEECH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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