Provider Demographics
NPI:1467002782
Name:SPEECH PATHWAYS - PEDIATRIC SPEECH THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:SPEECH PATHWAYS - PEDIATRIC SPEECH THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:559-741-9687
Mailing Address - Street 1:1017 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4117
Mailing Address - Country:US
Mailing Address - Phone:559-741-9687
Mailing Address - Fax:559-741-9694
Practice Address - Street 1:240 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4540
Practice Address - Country:US
Practice Address - Phone:559-741-9687
Practice Address - Fax:559-741-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty