Healthcare Provider Details

I. General information

NPI: 1841588084
Provider Name (Legal Business Name): LANGUAGE AND SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 EUCLID ST, SUITE 550
GARDEN GROVE CA
92840-9217
US

IV. Provider business mailing address

12966 EUCLID ST STE 550
GARDEN GROVE CA
92840-9217
US

V. Phone/Fax

Practice location:
  • Phone: 714-539-6207
  • Fax: 714-539-6209
Mailing address:
  • Phone: 714-539-6207
  • Fax: 714-539-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSP12385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberSP12385
License Number StateCA

VIII. Authorized Official

Name: MRS. JULIE CHAU DIEP
Title or Position: CLINICAL DIRECTOR
Credential: MS, CCC-SLP
Phone: 714-539-6207