Provider Demographics
NPI:1548784879
Name:LAGUNA NIGUEL SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:LAGUNA NIGUEL SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SLP
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC
Authorized Official - Phone:949-495-2171
Mailing Address - Street 1:30131 TOWN CENTER DR STE 235
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2033
Mailing Address - Country:US
Mailing Address - Phone:949-495-2171
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER
Practice Address - Street 2:SUITE 235
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-495-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP50235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty