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General NPI Number Information
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NPI Number | 1689108003
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Entity Type | Organization
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Legal Business Name | AIIM SF
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 41 BEACHMONT DR
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1607
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Country | US
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Telephone | 415-501-0158
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Fax |
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Provider Business Mailing Address
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Address Line | 41 BEACHMONT DR
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1607
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Country | US
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Telephone | 415-501-0158
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | MISS MICHELLE JOSEPHINE FONG
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Credential | M.S., CCC-SLP, CKTP
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Telephone | 415-501-0158
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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 | 16536
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License Number State | CA
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