Provider Demographics
NPI:1609237882
Name:SAN FRANCISCO SPEECH-LANGUAGE PATHOLOGY, INC
Entity Type:Organization
Organization Name:SAN FRANCISCO SPEECH-LANGUAGE PATHOLOGY, INC
Other - Org Name:SAN FRANCISCO SPEECH AND FLUENCY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:VENKATRAMAN
Authorized Official - Last Name:LEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:415-496-6757
Mailing Address - Street 1:PO BOX 318003
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-8003
Mailing Address - Country:US
Mailing Address - Phone:415-496-6757
Mailing Address - Fax:
Practice Address - Street 1:3401 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5419
Practice Address - Country:US
Practice Address - Phone:415-496-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SP20591261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech