Provider Demographics
NPI:1942236633
Name:CENTER FOR EARLY INTERVENTION ON DEAFNESS
Entity Type:Organization
Organization Name:CENTER FOR EARLY INTERVENTION ON DEAFNESS
Other - Org Name:CENTER FOR EARLY INTERVENTION ON DEAFNESS, CEID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-848-4800
Mailing Address - Street 1:1035 GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2642
Mailing Address - Country:US
Mailing Address - Phone:510-848-4800
Mailing Address - Fax:510-848-4801
Practice Address - Street 1:1035 GRAYSON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2642
Practice Address - Country:US
Practice Address - Phone:510-848-4800
Practice Address - Fax:510-848-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1906231H00000X
CAHA3963231HA2500X, 237600000X
CASP11949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA194514OtherPROVIDER NUMBER KAISER
CAGAU000920Medicaid