Provider Demographics
NPI:1295567121
Name:AVERHART COLLINS SPEECH LANGUAGE PATHOLOGY, INC.
Entity type:Organization
Organization Name:AVERHART COLLINS SPEECH LANGUAGE PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:AVERHART-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC,
Authorized Official - Phone:626-437-0173
Mailing Address - Street 1:1161 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3121
Mailing Address - Country:US
Mailing Address - Phone:626-437-0173
Mailing Address - Fax:
Practice Address - Street 1:9650 TELSTAR AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3011
Practice Address - Country:US
Practice Address - Phone:626-400-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center