Healthcare Provider Details

I. General information

NPI: 1639090285
Provider Name (Legal Business Name): VALLEY OF THE MOON SPEECH & LANGUAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 ARNOLD DR
SONOMA CA
95476-3242
US

IV. Provider business mailing address

17000 ARNOLD DR
SONOMA CA
95476-3242
US

V. Phone/Fax

Practice location:
  • Phone: 707-971-0341
  • Fax:
Mailing address:
  • Phone: 707-971-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKAELA KATHRYN KALAFATE-LUCCHETTI
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS., CCC-SLP
Phone: 707-971-0341