MEDICARE: RISING TIDE 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	:	1457208258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING TIDE SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	5450 E MEZZANINE WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 E MEZZANINE WAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-3538
Country	:	US
Telephone Number	:	562-481-2264
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RIA ANN WILSON
Credential	:
Telephone Number	:	562-481-2264

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “RISING TIDE SPEECH THERAPY, INC. ” Practice Location

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