Provider Demographics
NPI:1013127711
Name:BAY AREA SPEECH AND LANGUAGE CLINIC
Entity Type:Organization
Organization Name:BAY AREA SPEECH AND LANGUAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MEDCCC SLP
Authorized Official - Phone:408-776-1700
Mailing Address - Street 1:18525 SUTTER BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-776-1700
Mailing Address - Fax:408-776-1702
Practice Address - Street 1:18525 SUTTER BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8100
Practice Address - Country:US
Practice Address - Phone:408-776-1700
Practice Address - Fax:408-776-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA006712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty