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General NPI Number Information
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NPI Number | 1043720881
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Entity Type | Organization
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Legal Business Name | BLACK OAK SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 1160 SUNCAST LN STE 9
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9327
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Country | US
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Telephone | 530-728-0757
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Fax | 530-718-3527
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Provider Business Mailing Address
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Address Line | 1620 PASO DIABLO RD
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City | PLACERVILLE
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State | CA
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Zip | 95667-3023
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Country | US
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Telephone | 530-728-0757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX STEWART
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Credential |
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Telephone | 530-728-0757
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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 | 22500
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License Number State | CA
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