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General NPI Number Information
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NPI Number | 1740303841
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Entity Type | Individual
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Provider Name | DOUGLAS HOWARD FERGUSON SPEECH LANGUAGE PATH
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 120 W COLE RD SUITE B
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City | CALEXICO
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State | CA
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Zip | 92231-9700
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Country | US
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Telephone | 760-344-5431
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Fax | 760-344-8240
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Provider Business Mailing Address
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Address Line | 2040 DE PAOLI RD
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City | HOLTVILLE
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State | CA
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Zip | 92250-9500
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Country | US
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Telephone | 760-344-5431
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Fax | 760-344-8240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SP1975
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License Number State | CA
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