Provider Demographics
NPI:1134587967
Name:MILESTONE SPEECH THERAPY, INC
Entity type:Organization
Organization Name:MILESTONE SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FONDEVILLA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:818-245-6718
Mailing Address - Street 1:210 N CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2536
Mailing Address - Country:US
Mailing Address - Phone:818-245-6718
Mailing Address - Fax:818-245-6719
Practice Address - Street 1:210 N CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2536
Practice Address - Country:US
Practice Address - Phone:818-245-6718
Practice Address - Fax:818-245-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty