Provider Demographics
NPI:1659747509
Name:I HEART SPEECH THERAPY
Entity Type:Organization
Organization Name:I HEART SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERINA
Authorized Official - Middle Name:LETICE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:404-839-0420
Mailing Address - Street 1:400 ESTUDILLO AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4900
Mailing Address - Country:US
Mailing Address - Phone:404-839-0420
Mailing Address - Fax:510-842-1502
Practice Address - Street 1:400 ESTUDILLO AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4900
Practice Address - Country:US
Practice Address - Phone:404-839-0420
Practice Address - Fax:510-842-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty