Provider Demographics
NPI:1508385139
Name:UPWARD BOUND SPEECH THERAPY SERVICES INC
Entity Type:Organization
Organization Name:UPWARD BOUND SPEECH THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-838-2853
Mailing Address - Street 1:661 W 1ST ST STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2939
Mailing Address - Country:US
Mailing Address - Phone:714-838-2853
Mailing Address - Fax:714-838-4533
Practice Address - Street 1:661 W 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2939
Practice Address - Country:US
Practice Address - Phone:714-838-2853
Practice Address - Fax:714-838-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty