Healthcare Provider Details

I. General information

NPI: 1881150027
Provider Name (Legal Business Name): THERALINGUAL SPEECH PATHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KETTNER BLVD STE D360
SAN DIEGO CA
92101-3339
US

IV. Provider business mailing address

1050 KETTNER BLVD STE D360
SAN DIEGO CA
92101-3339
US

V. Phone/Fax

Practice location:
  • Phone: 858-247-1785
  • Fax: 844-946-2985
Mailing address:
  • Phone: 858-247-1785
  • Fax: 844-946-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHELE SHERIE SERRANO
Title or Position: PRESIDENT
Credential: MA CCC-SLP
Phone: 858-247-1785