Provider Demographics
NPI:1376268847
Name:MULTIMODAL COMMUNICATION SPEECH CLINIC P.C.
Entity Type:Organization
Organization Name:MULTIMODAL COMMUNICATION SPEECH CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-373-8874
Mailing Address - Street 1:18430 BROOKHURST ST STE 201H
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6757
Mailing Address - Country:US
Mailing Address - Phone:562-373-8874
Mailing Address - Fax:
Practice Address - Street 1:18430 BROOKHURST ST STE 201H
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6757
Practice Address - Country:US
Practice Address - Phone:562-373-8874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty