Provider Demographics
NPI:1972977213
Name:SPLASH FOR SPEECH, INC.
Entity Type:Organization
Organization Name:SPLASH FOR SPEECH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:310-876-1110
Mailing Address - Street 1:3637 MOTOR AVENUE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4884
Mailing Address - Country:US
Mailing Address - Phone:310-876-1110
Mailing Address - Fax:310-876-1114
Practice Address - Street 1:3637 MOTOR AVENUE
Practice Address - Street 2:SUITE 280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4884
Practice Address - Country:US
Practice Address - Phone:310-876-1110
Practice Address - Fax:310-876-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty