Healthcare Provider Details

I. General information

NPI: 1780441949
Provider Name (Legal Business Name): DBA CHILD DEVELOPMENT CENTER OF MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 REDWOOD HWY FRONTAGE RD
MILL VALLEY CA
94941-1621
US

IV. Provider business mailing address

1058 REDWOOD HWY FRONTAGE RD
MILL VALLEY CA
94941-1621
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-2444
  • Fax:
Mailing address:
  • Phone:
  • 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: DENISE FORD
Title or Position: CLINIC DIRECTOR
Credential: MS, SLP- CCC
Phone: 415-924-2444