MEDICARE: SYNERGY SPEECH THERAPY SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1003503269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY SPEECH THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	950 E KATELLA AVE STE 3
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5036
Country	:	US
Telephone Number	:	714-289-1418
Fax Number	:	714-475-3579

Provider Business Practice Location Address
First Line	:	950 E KATELLA AVE STE 3
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-5036
Country	:	US
Telephone Number	:	714-289-1418
Fax Number	:	714-475-3579

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	SUSAN MARIE MENDOZA
Credential	:	MS-CCC
Telephone Number	:	714-289-1418

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	04/19/2023

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