MEDICARE: BAKERSFIELD 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1346823325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKERSFIELD SPEECH THERAPY INC

Provider Business Mailing Address
First Line	:	2205 GAMBEL OAK WAY
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-1690
Country	:	US
Telephone Number	:	661-631-2229
Fax Number	:	661-742-1644

Provider Business Practice Location Address
First Line	:	4550 PANAMA LN STE 100
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-3486
Country	:	US
Telephone Number	:	818-943-0704
Fax Number	:	661-742-1644

Authorized Official
Title or Position	:	CEO
Name	:	BIDYARANI SHAMURAILATPAM
Credential	:	SLP
Telephone Number	:	661-631-2229

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	03/02/2022

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Directions to “BAKERSFIELD SPEECH THERAPY INC ” Practice Location

Language	Start Address	Practice Location

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