Provider Demographics
NPI:1578697959
Name:INNOVATIVE SPEECH THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:INNOVATIVE SPEECH THERAPY ASSOCIATES, INC.
Other - Org Name:INNOVATIVE THERAPY ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-783-5168
Mailing Address - Street 1:13400 RIVERSIDE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2500
Mailing Address - Country:US
Mailing Address - Phone:818-783-5168
Mailing Address - Fax:818-783-6176
Practice Address - Street 1:13400 RIVERSIDE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2500
Practice Address - Country:US
Practice Address - Phone:818-783-5168
Practice Address - Fax:818-783-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty