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General NPI Number Information
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NPI Number | 1881829778
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Entity Type | Organization
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Legal Business Name | MIND THE GAP...BRIDGING COMMUNICATION AND MORE
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 25115 AVENUE STANFORD SUITE B-121
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City | VALENCIA
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State | CA
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Zip | 91355-1290
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Country | US
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Telephone | 661-295-9696
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Fax | 661-295-3434
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Provider Business Mailing Address
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Address Line | 25115 AVENUE STANFORD SUITE B-121
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City | VALENCIA
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State | CA
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Zip | 91355-1290
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Country | US
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Telephone | 661-295-9696
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Fax | 661-295-3434
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | TIA HERRELL
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Credential | M.S.
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Telephone | 661-295-9696
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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 | 15024
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License Number State | CA
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