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General NPI Number Information
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NPI Number | 1003113408
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Entity Type | Organization
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Legal Business Name | PATHWAYS 2 SPEECH
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 719 FRANKLIN LN
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City | VISTA
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State | CA
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Zip | 92084-5153
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Country | US
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Telephone | 760-518-8563
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Fax | 760-480-7366
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Provider Business Mailing Address
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Address Line | 719 FRANKLIN LN
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City | VISTA
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State | CA
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Zip | 92084-5153
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Country | US
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Telephone | 760-518-8563
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Fax | 760-480-7366
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Authorized Official
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Title or Position | LSLS CERT. AVT, CCC-SLP
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Name | MRS. MARY ELIZABETH CLEMONS
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Credential | M.A.
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Telephone | 760-518-8563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP9784
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | CERT. AVT 1031201020
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License Number State | CA
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