Provider Demographics
NPI:1912005307
Name:HIGH DESERT SPEECH AND LANGUAGE PATHOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:HIGH DESERT SPEECH AND LANGUAGE PATHOLOGY CENTER, INC.
Other - Org Name:HIGH DESERT SPEECH AND LANGUAGE CENTER, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKIETA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:760-948-0702
Mailing Address - Street 1:16785 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-0825
Mailing Address - Country:US
Mailing Address - Phone:760-948-0702
Mailing Address - Fax:186-649-6043
Practice Address - Street 1:16785 BEAR VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-0825
Practice Address - Country:US
Practice Address - Phone:760-948-0702
Practice Address - Fax:186-649-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty