MEDICARE: TODDLER TALK 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	:	1871299081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TODDLER TALK SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	1180 ROSECRANS ST STE 104-520
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 WORDEN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5708
Country	:	US
Telephone Number	:	619-327-9649
Fax Number	:

Authorized Official
Title or Position	:	CEO, PRESIDENT
Name	:	STEPHANIE KEFFER HATLELI
Credential	:	MS CCC-SLP
Telephone Number	:	619-327-9649

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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