Provider Demographics
NPI:1497930812
Name:BAY AREA SPEECH LANGUAGE LEARNING ASSOC.
Entity Type:Organization
Organization Name:BAY AREA SPEECH LANGUAGE LEARNING ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:SWOFFORD
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC/SLP
Authorized Official - Phone:281-488-7221
Mailing Address - Street 1:1234 BAY AREA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2538
Mailing Address - Country:US
Mailing Address - Phone:281-488-7221
Mailing Address - Fax:281-488-2103
Practice Address - Street 1:1234 BAY AREA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2538
Practice Address - Country:US
Practice Address - Phone:281-488-7221
Practice Address - Fax:281-488-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7355592OtherAETNA
TX8T4351OtherBCBS