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General NPI Number Information
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NPI Number | 1225167646
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Entity Type | Organization
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Legal Business Name | ASSOCIATED SPEECH PATHOLOGISTS
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 1595 GRAND AVE SUITE 110
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City | SAN MARCOS
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State | CA
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Zip | 92078-2450
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Country | US
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Telephone | 760-471-1198
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Fax | 760-471-5657
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Provider Business Mailing Address
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Address Line | 1595 GRAND AVE SUITE 110
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City | SAN MARCOS
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State | CA
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Zip | 92078-2450
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Country | US
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Telephone | 760-471-1198
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Fax | 760-471-5657
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST OWNER
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Name | MARY ANNE MACLELLAN
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Credential | M.A., CCC, SLP
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Telephone | 760-471-1198
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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 | SP4920
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License Number State | CA
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