Provider Demographics
NPI:1003035569
Name:KIRSCH THERAPY SPEECH CLINIC, INC.
Entity Type:Organization
Organization Name:KIRSCH THERAPY SPEECH CLINIC, INC.
Other - Org Name:KIRSCH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:SCARBOROUGH
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:760-945-6500
Mailing Address - Street 1:1949 AVENIDA DEL ORO
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5829
Mailing Address - Country:US
Mailing Address - Phone:760-945-6500
Mailing Address - Fax:760-945-6535
Practice Address - Street 1:1949 AVENIDA DEL ORO
Practice Address - Street 2:SUITE 118
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5829
Practice Address - Country:US
Practice Address - Phone:760-945-6500
Practice Address - Fax:760-945-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT97372251P0200X
CAOT2082225XP0200X
CASP9882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65082ZMedicare UPIN