Provider Demographics
NPI:1548576168
Name:VALLEY SPEECH AND LANGUAGE REHABILITATION, INC.
Entity Type:Organization
Organization Name:VALLEY SPEECH AND LANGUAGE REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ-GOSTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-562-9286
Mailing Address - Street 1:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2975
Mailing Address - Country:US
Mailing Address - Phone:760-352-1628
Mailing Address - Fax:760-352-1628
Practice Address - Street 1:2366 18TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6176
Practice Address - Country:US
Practice Address - Phone:760-562-9286
Practice Address - Fax:760-352-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12075049OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
CASP 13118OtherSPEECH -LANGUAGE PATHOLOGY AND AUDIOLOGY BOARD