Healthcare Provider Details

I. General information

NPI: 1609626217
Provider Name (Legal Business Name): MOUNTAIN VOICE AND SPEECH THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SUTTON WAY
GRASS VALLEY CA
95945-4102
US

IV. Provider business mailing address

263 MANOR DR
GRASS VALLEY CA
95945-4003
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-8838
  • Fax: 530-389-3338
Mailing address:
  • Phone: 530-709-1408
  • Fax: 530-389-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL PECK ENG
Title or Position: PRESIDENT
Credential: MS, CCC-SLP
Phone: 530-709-1408