Provider Demographics
NPI:1689967630
Name:EXTENSIVE THERAPY CONNECTION AND SOLUTION
Entity Type:Organization
Organization Name:EXTENSIVE THERAPY CONNECTION AND SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAWMICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:951-332-7832
Mailing Address - Street 1:1618 FOX GLEN DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2929
Mailing Address - Country:US
Mailing Address - Phone:951-332-7832
Mailing Address - Fax:
Practice Address - Street 1:1618 FOX GLEN DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2929
Practice Address - Country:US
Practice Address - Phone:951-332-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14361251300000X
CA14383251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)