Provider Demographics
NPI:1639396286
Name:SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-544-1860
Mailing Address - Street 1:12791 NEWPORT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2751
Mailing Address - Country:US
Mailing Address - Phone:714-544-1860
Mailing Address - Fax:
Practice Address - Street 1:12791 NEWPORT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2751
Practice Address - Country:US
Practice Address - Phone:714-544-1860
Practice Address - Fax:714-730-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3165252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0031650OtherBLUE SHIELD
CASP31650OtherBLUE CROSS