Healthcare Provider Details

I. General information

NPI: 1205151693
Provider Name (Legal Business Name): ASSOCIATED LEARNING & LANGUAGE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 TWIN DOLPHIN DR SUITE 100
REDWOOD CITY CA
94065-1133
US

IV. Provider business mailing address

1060 TWIN DOLPHIN DR SUITE 100
REDWOOD CITY CA
94065-1133
US

V. Phone/Fax

Practice location:
  • Phone: 650-631-9999
  • Fax: 650-631-9988
Mailing address:
  • Phone: 650-631-9999
  • Fax: 650-631-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3566
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberREGIONAL CENTER
License Number StateCA

VIII. Authorized Official

Name: MS. PAMELA RUTH COLSTON-JOY
Title or Position: FOUNDER/CEO
Credential: M.A.
Phone: 650-631-9999