MEDICARE: LINGO SPEECH THERAPY SERVICES

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	:	1619102514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINGO SPEECH THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1110 CIVIC CENTER BLVD
Second Line	:	BLDG 202, SUITE C
City	:	YUBA CITY
State	:	CA
Zip	:	95993-3013
Country	:	US
Telephone Number	:	530-673-7333
Fax Number	:	530-673-3633

Provider Business Practice Location Address
First Line	:	1110 CIVIC CENTER BLVD
Second Line	:	BLDG 202, SUITE C
City	:	YUBA CITY
State	:	CA
Zip	:	95993-3013
Country	:	US
Telephone Number	:	530-673-7333
Fax Number	:	530-673-3633

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BRIDGET ANNE MCMAHON
Credential	:	SP11990
Telephone Number	:	530-673-7333

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “LINGO SPEECH THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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