Healthcare Provider Details

I. General information

NPI: 1902369911
Provider Name (Legal Business Name): INLAND CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 COMMERCE ST STE A
REDLANDS CA
92374-0110
US

IV. Provider business mailing address

35591 BELLA VISTA DR
YUCAIPA CA
92399-4903
US

V. Phone/Fax

Practice location:
  • Phone: 909-783-1111
  • Fax: 909-796-2122
Mailing address:
  • Phone: 909-225-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA MARIE DENOLF
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 909-225-3103