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General NPI Number Information
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NPI Number | 1508043134
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Entity Type | Organization
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Legal Business Name | DESERT SPEECH AND LANGUAGE CENTER, LLC
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 2171 SPARTAN VIEW CT
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City | LAS VEGAS
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State | NV
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Zip | 89123-2878
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Country | US
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Telephone | 702-622-6728
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 230773 DESERT SPEECH AND LANGUAGE CENTER, LLC
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City | LAS VEGAS
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State | NV
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Zip | 89105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KIM FORNI
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Credential | M.S. CCC-SLP
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Telephone | 702-622-6728
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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 | SP-1055
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License Number State | NV
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