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General NPI Number Information
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NPI Number | 1043636939
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Entity Type | Organization
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Legal Business Name | BAY AREA SPEECH PATHOLOGY STUDIO, INC.
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Dates
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Enumeration Date | 03/15/2014
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Last Update Date | 03/15/2014
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Provider Practice Location Address
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Address Line | 478 WARREN DR #311
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-1068
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Country | US
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Telephone | 415-213-2874
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Fax |
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Provider Business Mailing Address
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Address Line | 478 WARREN DR #311
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-1068
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Country | US
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Telephone | 415-213-2874
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | AMANDA NICOLE IHLE
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Credential | MA CCC-SLP
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Telephone | 414-339-4202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 18518
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License Number State | CA
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