Provider Demographics
NPI:1346562360
Name:TRICOUNTIES SPEECH SERVICES INC.
Entity Type:Organization
Organization Name:TRICOUNTIES SPEECH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOVITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MA SLP
Authorized Official - Phone:831-630-9044
Mailing Address - Street 1:591 MCCRAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-2224
Mailing Address - Country:US
Mailing Address - Phone:831-630-9044
Mailing Address - Fax:831-637-5925
Practice Address - Street 1:591 MCCRAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-2224
Practice Address - Country:US
Practice Address - Phone:831-630-9044
Practice Address - Fax:831-637-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty