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General NPI Number Information
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NPI Number | 1972127249
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Entity Type | Organization
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Legal Business Name | SPARKLING SPEECH THERAPY INC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 4600 S TRACY BLVD STE 118
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City | TRACY
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State | CA
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Zip | 95377-8105
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Country | US
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Telephone | 209-605-6865
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 CUTTER CT
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City | SAN RAMON
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State | CA
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Zip | 94583-2680
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Country | US
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Telephone | 209-605-6865
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
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Name | MISS RADHA R MAKKER
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Credential | M.S. CCC-SLP
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Telephone | 209-605-6865
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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 |
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License Number State |
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