Provider Demographics
NPI:1659003804
Name:PHILLIPS SPEECH THERAPY CORP
Entity Type:Organization
Organization Name:PHILLIPS SPEECH THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:909-747-4298
Mailing Address - Street 1:24551 DEL PRADO UNIT 4154
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-6302
Mailing Address - Country:US
Mailing Address - Phone:909-747-4298
Mailing Address - Fax:
Practice Address - Street 1:439 N EL CAMINO REAL STE D
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4700
Practice Address - Country:US
Practice Address - Phone:909-747-4298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891313839Medicaid