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General NPI Number Information
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NPI Number | 1679691703
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Entity Type | Organization
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Legal Business Name | LIFE SPIRIT SPEECH PATHOLOGY INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 26284 OSO RD SUITE 114
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1629
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Country | US
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Telephone | 949-842-9557
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Fax |
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Provider Business Mailing Address
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Address Line | 26284 OSO RD SUITE 114
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1629
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Country | US
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Telephone | 949-842-9557
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | TERRI HUTCHISON
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Credential | M.A., CCC-SLP
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Telephone | 949-842-9557
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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 | 14538
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License Number State | CA
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