Provider Demographics
NPI:1073122933
Name:SPEECH WAVES
Entity Type:Organization
Organization Name:SPEECH WAVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:805-547-1755
Mailing Address - Street 1:187 TANK FARM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7085
Mailing Address - Country:US
Mailing Address - Phone:805-547-1755
Mailing Address - Fax:805-439-2124
Practice Address - Street 1:187 TANK FARM RD STE 210
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7085
Practice Address - Country:US
Practice Address - Phone:805-547-1755
Practice Address - Fax:805-439-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB353353Medicaid