Healthcare Provider Details

I. General information

NPI: 1669201588
Provider Name (Legal Business Name): INCLUSION SPEECH THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 PORTALS AVE
CLOVIS CA
93619-9380
US

IV. Provider business mailing address

3066 PORTALS AVE
CLOVIS CA
93619-9380
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-6390
  • Fax:
Mailing address:
  • Phone: 559-779-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BERTAO
Title or Position: CEO
Credential: M.A.
Phone: 559-779-6390