=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245990613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHICO SPEECH AND LANGUAGE PATHOLOGY INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2021
-----------------------------------------------------
Last Update Date | 12/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2627 FOREST AVE
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95928-4384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-894-0702
-----------------------------------------------------
Fax | 530-894-0905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2627 FOREST AVE
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95928-4384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-894-0702
-----------------------------------------------------
Fax | 530-894-0905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CYNTHIA TAYLOR PERRY
-----------------------------------------------------
Credential | M.A.C.C.C
-----------------------------------------------------
Telephone | 530-894-0702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------