Healthcare Provider Details

I. General information

NPI: 1558296178
Provider Name (Legal Business Name): EXCEL EDUCATION & THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 FOOTHILL AVE
NORTH EDWARDS CA
93523-3533
US

IV. Provider business mailing address

626 W LANCASTER BLVD # 81
LANCASTER CA
93534-3108
US

V. Phone/Fax

Practice location:
  • Phone: 760-769-4821
  • Fax:
Mailing address:
  • Phone: 661-350-2504
  • 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: MR. WYNELL MONTGOMERY
Title or Position: DATA/OPERATIONS MANAGER
Credential: MA
Phone: 661-350-2504