Healthcare Provider Details

I. General information

NPI: 1003035569
Provider Name (Legal Business Name): KIRSCH THERAPY SPEECH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 AVENIDA DEL ORO SUITE 118
OCEANSIDE CA
92056-5829
US

IV. Provider business mailing address

1949 AVENIDA DEL ORO SUITE 118
OCEANSIDE CA
92056-5829
US

V. Phone/Fax

Practice location:
  • Phone: 760-945-6500
  • Fax: 760-945-6535
Mailing address:
  • Phone: 760-945-6500
  • Fax: 760-945-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT9737
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2082
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP9882
License Number StateCA

VIII. Authorized Official

Name: MRS. LYNN SCARBOROUGH KIRSCH
Title or Position: PRESIDENT
Credential: M.A., CCC-SLP
Phone: 760-945-6500