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General NPI Number Information
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NPI Number | 1780441949
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Entity Type | Organization
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Legal Business Name | DBA CHILD DEVELOPMENT CENTER OF MARIN
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 1058 REDWOOD HWY FRONTAGE RD
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City | MILL VALLEY
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State | CA
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Zip | 94941-1621
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Country | US
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Telephone | 415-924-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 REDWOOD HWY FRONTAGE RD
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City | MILL VALLEY
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State | CA
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Zip | 94941-1621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DENISE FORD
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Credential | MS, SLP- CCC
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Telephone | 415-924-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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