Provider Demographics
NPI:1881829778
Name:MIND THE GAP...BRIDGING COMMUNICATION AND MORE
Entity Type:Organization
Organization Name:MIND THE GAP...BRIDGING COMMUNICATION AND MORE
Other - Org Name:MIND THE GAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:661-295-9696
Mailing Address - Street 1:25115 AVENUE STANFORD
Mailing Address - Street 2:SUITE B-121
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-295-9696
Mailing Address - Fax:661-295-3434
Practice Address - Street 1:25115 AVENUE STANFORD
Practice Address - Street 2:SUITE B-121
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1290
Practice Address - Country:US
Practice Address - Phone:661-295-9696
Practice Address - Fax:661-295-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty