Provider Demographics
NPI:1992853113
Name:SPEECH PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JANEAN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:951-303-9422
Mailing Address - Street 1:31935 CALLE ESPINOSA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3743
Mailing Address - Country:US
Mailing Address - Phone:951-303-9422
Mailing Address - Fax:951-303-9432
Practice Address - Street 1:31935 CALLE ESPINOSA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3743
Practice Address - Country:US
Practice Address - Phone:951-303-9422
Practice Address - Fax:951-303-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP4814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2064835Medicaid