Healthcare Provider Details

I. General information

NPI: 1861083776
Provider Name (Legal Business Name): NATALIE NEAL SPEECH LANGUAGE PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20162 SW BIRCH ST STE 350
NEWPORT BEACH CA
92660-0790
US

IV. Provider business mailing address

20162 SW BIRCH ST STE 350
NEWPORT BEACH CA
92660-0790
US

V. Phone/Fax

Practice location:
  • Phone: 714-396-8685
  • Fax: 949-610-7660
Mailing address:
  • Phone: 714-396-8685
  • Fax: 949-610-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIE NEAL
Title or Position: CCC-SLP
Credential: M.A.
Phone: 714-396-8685