Provider Demographics
NPI:1063467199
Name:SPEECH THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:SPEECH THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:SP
Authorized Official - Phone:530-247-1490
Mailing Address - Street 1:1852 BUENAVENTURA BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-6315
Mailing Address - Country:US
Mailing Address - Phone:530-247-1490
Mailing Address - Fax:530-247-1431
Practice Address - Street 1:1852 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-6315
Practice Address - Country:US
Practice Address - Phone:530-247-1490
Practice Address - Fax:530-247-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty