Provider Demographics
NPI:1043636939
Name:BAY AREA SPEECH PATHOLOGY STUDIO, INC.
Entity Type:Organization
Organization Name:BAY AREA SPEECH PATHOLOGY STUDIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:IHLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:414-339-4202
Mailing Address - Street 1:478 WARREN DR
Mailing Address - Street 2:#311
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1068
Mailing Address - Country:US
Mailing Address - Phone:415-213-2874
Mailing Address - Fax:
Practice Address - Street 1:478 WARREN DR
Practice Address - Street 2:#311
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1068
Practice Address - Country:US
Practice Address - Phone:415-213-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18518261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech