Healthcare Provider Details

I. General information

NPI: 1093529711
Provider Name (Legal Business Name): THE SPEECH THERAPY COTTAGE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 MAIN ST
RAMONA CA
92065-2044
US

IV. Provider business mailing address

PO BOX 3779
RAMONA CA
92065-0964
US

V. Phone/Fax

Practice location:
  • Phone: 858-869-3256
  • Fax:
Mailing address:
  • Phone: 858-869-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LAUREN MCNAMARA
Title or Position: CEO
Credential: CEO & MS, CCC-SLP
Phone: 858-869-3256