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General NPI Number Information
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NPI Number | 1518381946
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Entity Type | Organization
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Legal Business Name | PROGRESS SPEECH AND LANGUAGE CENTER
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 217 W CERRITOS AVE
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City | ANAHEIM
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State | CA
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Zip | 92805-6549
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Country | US
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Telephone | 714-776-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 217 W CERRITOS AVE
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City | ANAHEIM
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State | CA
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Zip | 92805-6549
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Country | US
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Telephone | 714-776-1231
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JAMIE WOLF
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Credential | M.A., OTR/L
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Telephone | 949-300-6345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 14047
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License Number State | CA
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