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General NPI Number Information
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NPI Number | 1962031302
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Entity Type | Organization
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Legal Business Name | KOALA BILINGUAL SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 30161 PACIFIC ISLAND DR APT 125
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-6307
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Country | US
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Telephone | 202-779-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 29911 NIGUEL RD UNIT 6512
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-2421
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Country | US
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Telephone | 949-393-7799
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | DEANNE WAYT
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Credential | MA, CCC-SLP
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Telephone | 202-779-3771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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