Provider Demographics
NPI:1346487089
Name:THE SPEECH & LANGUAGE GROUP, INC.
Entity Type:Organization
Organization Name:THE SPEECH & LANGUAGE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VIGIL-OLSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:213-353-9019
Mailing Address - Street 1:1930 WILSHIRE BLVD STE 904
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3619
Mailing Address - Country:US
Mailing Address - Phone:213-353-9019
Mailing Address - Fax:213-353-0336
Practice Address - Street 1:1930 WILSHIRE BLVD STE 904
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3619
Practice Address - Country:US
Practice Address - Phone:213-353-9019
Practice Address - Fax:213-353-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA11518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4800836Medicare PIN