=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518552678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINY BABBLES SPEECH THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2021
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29970 TECHNOLOGY DR STE 219
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-290-8147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29970 TECHNOLOGY DR STE 219
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-290-8147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/SPEECHLANGUAGEPATHOLOGIST
-----------------------------------------------------
Name | MRS. ALYSSA NOELLE NOVALES KUNG-GUNION
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 951-290-8147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------