Healthcare Provider Details

I. General information

NPI: 1558740274
Provider Name (Legal Business Name): SPEECH THERAPY PARTNERS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15901 HAWTHORNE BLVD #140
LAWNDALE CA
90260
US

IV. Provider business mailing address

15901 HAWTHORNE BLVD #140
LAWNDALE CA
90260
US

V. Phone/Fax

Practice location:
  • Phone: 424-257-1533
  • Fax: 310-370-2339
Mailing address:
  • Phone: 424-257-1533
  • Fax: 310-370-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSP 18425
License Number StateCA

VIII. Authorized Official

Name: MRS. JULIE KRISTIE CARRILLO
Title or Position: PRESIDENT
Credential: M.A. CCC-SLP
Phone: 424-257-1533