Provider Demographics
NPI:1154855914
Name:AMERICAN RIVER SPEECH THERAPY INCORPORATED
Entity Type:Organization
Organization Name:AMERICAN RIVER SPEECH THERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICALK DIRECTOR/SLP
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:916-631-0428
Mailing Address - Street 1:11344 COLOMA RD STE 810
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD STE 810
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4465
Practice Address - Country:US
Practice Address - Phone:916-631-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16930261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech