MEDICARE: PHILLIPS SPEECH THERAPY CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659003804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIPS SPEECH THERAPY CORP

Provider Business Mailing Address
First Line	:	24551 DEL PRADO UNIT 4154
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-6302
Country	:	US
Telephone Number	:	909-747-4298
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 N EL CAMINO REAL STE D
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	909-747-4298
Fax Number	:

Authorized Official
Title or Position	:	LEAD SPEECH THERAPIST
Name	:	RILEY PHILLIPS
Credential	:	MS, CCC-SLP
Telephone Number	:	909-747-4298

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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Directions to “PHILLIPS SPEECH THERAPY CORP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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