Provider Demographics
NPI:1467050179
Name:SMALL TOWN SPEECH & LANGUAGE, INC.
Entity Type:Organization
Organization Name:SMALL TOWN SPEECH & LANGUAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:URSULA MATEJKA
Authorized Official - Last Name:TANK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:510-367-9140
Mailing Address - Street 1:20 PERKINS CT
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2223
Mailing Address - Country:US
Mailing Address - Phone:925-392-5984
Mailing Address - Fax:
Practice Address - Street 1:20 PERKINS CT
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-2223
Practice Address - Country:US
Practice Address - Phone:925-392-5984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty