Provider Demographics
NPI:1972960490
Name:THE SPEECH THERAPY GROUP
Entity Type:Organization
Organization Name:THE SPEECH THERAPY GROUP
Other - Org Name:LAUREN STOWE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-458-2232
Mailing Address - Street 1:1215 JOYCE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5324
Mailing Address - Country:US
Mailing Address - Phone:805-458-2232
Mailing Address - Fax:
Practice Address - Street 1:1304 ELLA ST STE B2
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4162
Practice Address - Country:US
Practice Address - Phone:805-458-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23498235Z00000X
CA20023235Z00000X
CA13748235Z00000X
CA13476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FO918AOtherMEDICARE PTAN