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General NPI Number Information
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NPI Number | 1578315420
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Entity Type | Organization
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Legal Business Name | THE PROAACTIVE SLP
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 140 MAYHEW WAY STE 700
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4375
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Country | US
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Telephone | 925-586-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 2043 EAST ST # 685
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City | CONCORD
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State | CA
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Zip | 94520-2126
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Country | US
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Telephone | 925-586-2994
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Fax | 925-420-7336
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Authorized Official
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Title or Position | CEO/OWNER, SPEECH LANG. PATHOLOGIST
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Name | CARRIE BALICK
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Credential | CCC-SLP
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Telephone | 925-586-2994
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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 |
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License Number State |
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