Provider Demographics
NPI:1023270725
Name:M & M CHILDREN'S SERVICES
Entity type:Organization
Organization Name:M & M CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:TICICH
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH THERAPIST
Authorized Official - Phone:951-587-6405
Mailing Address - Street 1:27520 ENTERPRISE CIR W STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4828
Mailing Address - Country:US
Mailing Address - Phone:951-587-6405
Mailing Address - Fax:
Practice Address - Street 1:27520 ENTERPRISE CIR W STE B
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4828
Practice Address - Country:US
Practice Address - Phone:951-587-6405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2862225X00000X
CASP 4960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty