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General NPI Number Information
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NPI Number | 1538525274
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Entity Type | Organization
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Legal Business Name | THE SPEECH LAB INCOPORATED
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 2900 BRISTOL ST STE E203
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City | COSTA MESA
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State | CA
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Zip | 92626-7908
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Country | US
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Telephone | 714-580-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 BUCKINGHAM DR APARTMENT B
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City | COSTA MESA
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State | CA
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Zip | 92626-2129
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Country | US
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Telephone | 714-580-4888
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. JESSE COYLE
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Credential | M.S., CCC-SLP
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Telephone | 714-580-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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