Provider Demographics
NPI:1467764316
Name:PROGRESS SPEECH & LANGUAGE PATHOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:PROGRESS SPEECH & LANGUAGE PATHOLOGY CENTER, INC.
Other - Org Name:PROGRESS SPEECH & LANGUAGE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-542-1234
Mailing Address - Street 1:2020 N BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2622
Mailing Address - Country:US
Mailing Address - Phone:714-776-1231
Mailing Address - Fax:714-776-0802
Practice Address - Street 1:217 W CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6549
Practice Address - Country:US
Practice Address - Phone:714-776-1231
Practice Address - Fax:714-776-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40121225100000X
CAOT 14047225X00000X
CASP12464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty