Provider Demographics
NPI:1205338332
Name:SPEECH THERAPY MARIN
Entity type:Organization
Organization Name:SPEECH THERAPY MARIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC - SLP
Authorized Official - Phone:415-924-2444
Mailing Address - Street 1:1058 REDWOOD HWY FRONTAGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1660
Mailing Address - Country:US
Mailing Address - Phone:415-924-2444
Mailing Address - Fax:415-924-2442
Practice Address - Street 1:1058 REDWOOD HWY FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1660
Practice Address - Country:US
Practice Address - Phone:415-924-2444
Practice Address - Fax:415-924-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty