Provider Demographics
NPI:1811213424
Name:SAN DIEGO COUNTY SPEECH PATHOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:SAN DIEGO COUNTY SPEECH PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-574-8181
Mailing Address - Street 1:411 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3530
Mailing Address - Country:US
Mailing Address - Phone:619-574-8181
Mailing Address - Fax:619-574-0802
Practice Address - Street 1:411 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3530
Practice Address - Country:US
Practice Address - Phone:619-574-8181
Practice Address - Fax:619-574-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty