Provider Demographics
NPI:1942851316
Name:AVID SPEECH THERAPY
Entity Type:Organization
Organization Name:AVID SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:714-642-5420
Mailing Address - Street 1:10061 TALBERT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5159
Mailing Address - Country:US
Mailing Address - Phone:714-272-3090
Mailing Address - Fax:714-849-5393
Practice Address - Street 1:10061 TALBERT AVE STE 104
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5159
Practice Address - Country:US
Practice Address - Phone:714-272-3090
Practice Address - Fax:714-849-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty