Healthcare Provider Details

I. General information

NPI: 1265367288
Provider Name (Legal Business Name): HIGH TIDE SPEECH AND LANGUAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 SANDCASTLE
ALISO VIEJO CA
92656-3839
US

IV. Provider business mailing address

244 SANDCASTLE
ALISO VIEJO CA
92656-3839
US

V. Phone/Fax

Practice location:
  • Phone: 949-842-4535
  • Fax:
Mailing address:
  • Phone: 949-842-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA LEA JESSEN
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 949-842-4535