MEDICARE: SHORE PATH SPEECH THERAPY

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	251E00000X	Home Health Agency
2	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1679381214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE PATH SPEECH THERAPY

Provider Business Mailing Address
First Line	:	1968 S COAST HWY # 216
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 CALIFORNIA ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-9224
Country	:	US
Telephone Number	:	424-262-6519
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER REED
Credential	:	CCC-SLP
Telephone Number	:	424-262-6519

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	06/25/2025

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Directions to “SHORE PATH SPEECH THERAPY ” Practice Location

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