Healthcare Provider Details

I. General information

NPI: 1306241112
Provider Name (Legal Business Name): BAY AREA SOUND SPEECH AND HEARING CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 RHODE ISLAND ST SUITE 101
SAN FRANCISCO CA
94103-5168
US

IV. Provider business mailing address

251 RHODE ISLAND ST SUITE 101
SAN FRANCISCO CA
94103-5168
US

V. Phone/Fax

Practice location:
  • Phone: 415-364-8774
  • Fax:
Mailing address:
  • Phone: 415-364-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22257
License Number StateCA

VIII. Authorized Official

Name: JOANNA VAYNSHTOK
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 415-364-8774