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General NPI Number Information
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NPI Number | 1194194019
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Entity Type | Organization
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Legal Business Name | CHANNEL TO WORDS SPEECH THERAPY INC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 111 S GARFIELD AVE STE 103
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City | MONTEBELLO
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State | CA
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Zip | 90640-3806
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Country | US
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Telephone | 323-767-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 111 S GARFIELD AVE STE 103
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City | MONTEBELLO
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State | CA
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Zip | 90640-3806
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Country | US
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Telephone | 323-767-4849
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | KIESHA MARTINEZ-SCOTT
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Credential | M.A., CCC-SLP
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Telephone | 323-767-4849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 18683
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License Number State | CA
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