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

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