MEDICARE: SPUNKY SPEECH THERAPY, INC.

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	:	1386529204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPUNKY SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	1501 INDIA ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2446
Country	:	US
Telephone Number	:	626-543-3073
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 A ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4258
Country	:	US
Telephone Number	:	626-543-3073
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHLOE CONRAD
Credential	:	M.S., CCC-SLP
Telephone Number	:	626-543-3073

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/08/2025

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Directions to “SPUNKY SPEECH THERAPY, INC. ” Practice Location

Language	Start Address	Practice Location

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