MEDICARE: THE VILLAGE SPEECH THERAPY 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	:	1083392989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE SPEECH THERAPY INC.

Provider Business Mailing Address
First Line	:	4770 32ND ST APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1692
Country	:	US
Telephone Number	:	251-554-6349
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 32ND ST APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1692
Country	:	US
Telephone Number	:	251-554-6349
Fax Number	:

Authorized Official
Title or Position	:	CEO/CFO/SECRETARY
Name	:	MISS LACEY DENT
Credential	:	M.S.CCC-SLP
Telephone Number	:	251-554-6349

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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