Provider Demographics
NPI:1083215792
Name:ITHERAPY, A SPEECH PATHOLOGY CORPORATION
Entity Type:Organization
Organization Name:ITHERAPY, A SPEECH PATHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/SPEECH-LANGUAGE PATHOLOG
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGGEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-656-3688
Mailing Address - Street 1:955 WALNUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592
Mailing Address - Country:US
Mailing Address - Phone:707-651-9915
Mailing Address - Fax:
Practice Address - Street 1:955 WALNUT AVENUE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592
Practice Address - Country:US
Practice Address - Phone:707-651-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty