Provider Demographics
NPI:1609626217
Name:MOUNTAIN VOICE AND SPEECH THERAPY
Entity Type:Organization
Organization Name:MOUNTAIN VOICE AND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:530-709-1408
Mailing Address - Street 1:263 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4003
Mailing Address - Country:US
Mailing Address - Phone:530-709-1408
Mailing Address - Fax:530-389-3338
Practice Address - Street 1:120 RICHARDSON ST UNIT 7
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6363
Practice Address - Country:US
Practice Address - Phone:530-264-8838
Practice Address - Fax:530-389-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech