Provider Demographics
NPI:1942770417
Name:PENINSULA ASSOCIATES SPEECH THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PENINSULA ASSOCIATES SPEECH THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:650-743-7217
Mailing Address - Street 1:760 POLHEMUS RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3938
Mailing Address - Country:US
Mailing Address - Phone:650-349-8717
Mailing Address - Fax:650-750-0863
Practice Address - Street 1:760 POLHEMUS RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3938
Practice Address - Country:US
Practice Address - Phone:650-349-8717
Practice Address - Fax:650-750-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty