Provider Demographics
NPI:1568005312
Name:SPRING SPEECH THERAPY, PC
Entity Type:Organization
Organization Name:SPRING SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAFTARY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:650-918-6321
Mailing Address - Street 1:857 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1601
Mailing Address - Country:US
Mailing Address - Phone:650-918-6321
Mailing Address - Fax:503-296-2850
Practice Address - Street 1:425 HARBOR BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4048
Practice Address - Country:US
Practice Address - Phone:206-450-0562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23702OtherSLP LICENSE