Provider Demographics
NPI:1861006868
Name:KIDSPEAK SPEECH-LANGUAGE THERAPY SERVICES INC
Entity Type:Organization
Organization Name:KIDSPEAK SPEECH-LANGUAGE THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MA, CCC-SLP
Authorized Official - Phone:714-494-6252
Mailing Address - Street 1:700 E BIRCH ST UNIT 1133
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-2054
Mailing Address - Country:US
Mailing Address - Phone:714-494-6252
Mailing Address - Fax:
Practice Address - Street 1:210 W BIRCH ST STE 206
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4504
Practice Address - Country:US
Practice Address - Phone:714-494-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962965053Medicaid