Provider Demographics
NPI:1689893075
Name:EXPRESSIONS SPEECH LANGUAGE PATHOLOGY SERVICES INC
Entity Type:Organization
Organization Name:EXPRESSIONS SPEECH LANGUAGE PATHOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR, CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:714-901-1518
Mailing Address - Street 1:12062 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 137
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1737
Mailing Address - Country:US
Mailing Address - Phone:714-901-1518
Mailing Address - Fax:714-901-1359
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 137
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-901-1518
Practice Address - Fax:714-901-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2857447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty