=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134949407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARPINTERIA SPEECH AND LANGUAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 10/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5166 EL CARRO LN
-----------------------------------------------------
City | CARPINTERIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93013-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-705-9154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5166 EL CARRO LN
-----------------------------------------------------
City | CARPINTERIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93013-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-705-9154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SLP
-----------------------------------------------------
Name | LAUREN MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-705-9154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------