Provider Demographics
NPI:1629204904
Name:ADVANTES SPEECH CLINIC INC
Entity Type:Organization
Organization Name:ADVANTES SPEECH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:YING-JU
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:626-329-1661
Mailing Address - Street 1:1142 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2203
Mailing Address - Country:US
Mailing Address - Phone:626-329-1661
Mailing Address - Fax:626-608-2947
Practice Address - Street 1:133 E BONITA AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3173
Practice Address - Country:US
Practice Address - Phone:626-329-1661
Practice Address - Fax:626-608-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11838261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech