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General NPI Number Information
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NPI Number | 1316160286
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY SERVICES OF MARIN SONOMA INCORPORATED
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 N SAN PEDRO RD SUITE 265
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City | SAN RAFAEL
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State | CA
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Zip | 94903-4118
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Country | US
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Telephone | 415-479-7880
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Fax | 415-479-7889
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Provider Business Mailing Address
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Address Line | 30 N SAN PEDRO RD SUITE 265
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City | SAN RAFAEL
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State | CA
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Zip | 94903-4118
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Country | US
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Telephone | 415-479-7880
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Fax | 415-479-7889
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Authorized Official
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Title or Position | CFO CLINICAL DIRECTOR
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Name | ROBIN ROSSMAN
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Credential | M.A.C.C.C.SLP
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Telephone | 415-479-7880
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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 |
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License Number State |
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