Provider Demographics
NPI:1043311533
Name:GENESIS SPEECH AND LANGUAGE ASSOCIATES INC
Entity Type:Organization
Organization Name:GENESIS SPEECH AND LANGUAGE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SPEECHLANGUAGEPATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC,LICENSE SP
Authorized Official - Phone:626-963-8080
Mailing Address - Street 1:2605 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4003
Mailing Address - Country:US
Mailing Address - Phone:626-963-8080
Mailing Address - Fax:
Practice Address - Street 1:2605 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4003
Practice Address - Country:US
Practice Address - Phone:626-963-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty