Provider Demographics
NPI:1144955964
Name:CONVERSA SPEECH & LANGUAGE THERAPY, PC
Entity type:Organization
Organization Name:CONVERSA SPEECH & LANGUAGE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:707-343-8063
Mailing Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2159
Mailing Address - Country:US
Mailing Address - Phone:707-343-8063
Mailing Address - Fax:707-806-0227
Practice Address - Street 1:320 PROFESSIONAL CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2159
Practice Address - Country:US
Practice Address - Phone:707-343-8063
Practice Address - Fax:707-806-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty