Provider Demographics
NPI:1376042226
Name:SOCIAL BUTTERFLY SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:SOCIAL BUTTERFLY SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOCE-CAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:510-501-4044
Mailing Address - Street 1:32484 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5007
Mailing Address - Country:US
Mailing Address - Phone:510-501-4044
Mailing Address - Fax:
Practice Address - Street 1:32145 ALVARADO NILES RD STE 201
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2930
Practice Address - Country:US
Practice Address - Phone:510-501-4044
Practice Address - Fax:510-501-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty