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General NPI Number Information
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NPI Number | 1558610014
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Entity Type | Organization
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Legal Business Name | CENTER FOR SPEECH & LANGUAGE THERAPY
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 312 W J ST SUITE 202
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City | LOS BANOS
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State | CA
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Zip | 93635-4073
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Country | US
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Telephone | 209-827-1500
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Fax | 209-827-1300
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Provider Business Mailing Address
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Address Line | 312 W J ST SUITE 202
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City | LOS BANOS
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State | CA
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Zip | 93635-4073
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Country | US
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Telephone | 209-827-1500
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Fax | 209-827-1300
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Authorized Official
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Title or Position | OWNER
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Name | SHILA RUSSELL
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Credential | M.S., CCC-SLP
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Telephone | 209-827-1500
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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 | 14526
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License Number State | CA
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