Provider Demographics
NPI:1003113408
Name:PATHWAYS 2 SPEECH
Entity Type:Organization
Organization Name:PATHWAYS 2 SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LSLS CERT. AVT, CCC-SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:760-518-8563
Mailing Address - Street 1:719 FRANKLIN LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5153
Mailing Address - Country:US
Mailing Address - Phone:760-518-8563
Mailing Address - Fax:760-480-7366
Practice Address - Street 1:719 FRANKLIN LN
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5153
Practice Address - Country:US
Practice Address - Phone:760-518-8563
Practice Address - Fax:760-480-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERT. AVT 1031201020231H00000X
CASP9784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty