Healthcare Provider Details

I. General information

NPI: 1457208258
Provider Name (Legal Business Name): RISING TIDE SPEECH THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 E MEZZANINE WAY
LONG BEACH CA
90808-3538
US

IV. Provider business mailing address

5450 E MEZZANINE WAY
LONG BEACH CA
90808-3538
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-2264
  • Fax:
Mailing address:
  • Phone:
  • 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: RIA ANN WILSON
Title or Position: PRESIDENT
Credential:
Phone: 562-481-2264