Provider Demographics
NPI:1235532599
Name:TUSTIN SPEECH THERAPY, INC
Entity Type:Organization
Organization Name:TUSTIN SPEECH THERAPY, INC
Other - Org Name:TUSTIN SPEECH THERAPY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYMRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC
Authorized Official - Phone:714-838-2853
Mailing Address - Street 1:661 W 1ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2939
Mailing Address - Country:US
Mailing Address - Phone:714-838-2853
Mailing Address - Fax:
Practice Address - Street 1:661 W 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2939
Practice Address - Country:US
Practice Address - Phone:714-838-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUSTIN SPEECH THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech