Provider Demographics
NPI:1659845766
Name:OCEAN BEACH SPEECH
Entity Type:Organization
Organization Name:OCEAN BEACH SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WINNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:619-560-1270
Mailing Address - Street 1:4870 SANTA MONICA AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-4802
Mailing Address - Country:US
Mailing Address - Phone:619-560-1270
Mailing Address - Fax:
Practice Address - Street 1:4870 SANTA MONICA AVE STE 2B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-4802
Practice Address - Country:US
Practice Address - Phone:619-560-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech