Provider Demographics
NPI:1689108003
Name:AIIM SF
Entity Type:Organization
Organization Name:AIIM SF
Other - Org Name:ASCENDING IN INDIVIDUAL MINDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CKTP
Authorized Official - Phone:415-501-0158
Mailing Address - Street 1:41 BEACHMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1607
Mailing Address - Country:US
Mailing Address - Phone:415-501-0158
Mailing Address - Fax:
Practice Address - Street 1:41 BEACHMONT DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1607
Practice Address - Country:US
Practice Address - Phone:415-501-0158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty