=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376126680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ICOMMUNICATE SPEECH THERAPY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2021
-----------------------------------------------------
Last Update Date | 05/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 BRISA DEL MAR
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-9730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-345-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 BRISA DEL MAR
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-9730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-345-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIANA LORELLE MORIARTY
-----------------------------------------------------
Credential | MA, CCC, SLP
-----------------------------------------------------
Telephone | 831-345-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------