Provider Demographics
NPI:1609180397
Name:EDUCATIONAL THERAPY ASSESSMENT & SERVICES, INC.
Entity Type:Organization
Organization Name:EDUCATIONAL THERAPY ASSESSMENT & SERVICES, INC.
Other - Org Name:ETAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:909-795-4255
Mailing Address - Street 1:34590 COUNTY LINE RD.
Mailing Address - Street 2:SUITE 7
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-795-4255
Mailing Address - Fax:909-795-4438
Practice Address - Street 1:34590 COUNTY LINE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5303
Practice Address - Country:US
Practice Address - Phone:909-795-4255
Practice Address - Fax:909-795-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHJ0732252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency