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General NPI Number Information
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NPI Number | 1912247636
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Entity Type | Organization
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Legal Business Name | TACKLE TALK SPEECH THERAPY
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 3150 18TH ST SUITE 273
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2074
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Country | US
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Telephone | 415-823-2246
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 FILBERT ST 1F
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-3674
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Country | US
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Telephone | 415-823-2246
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANNE LACSON-SEIFERLE
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Credential | MS, CCC-SLP
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Telephone | 415-823-2246
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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 | 18321
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License Number State | CA
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