Provider Demographics
NPI:1295717676
Name:MST SPEECH & LANGUAGE CENTER INC.
Entity type:Organization
Organization Name:MST SPEECH & LANGUAGE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TECHAU
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:805-544-8840
Mailing Address - Street 1:4251 S HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7700
Mailing Address - Country:US
Mailing Address - Phone:805-544-8840
Mailing Address - Fax:805-544-8842
Practice Address - Street 1:4251 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7700
Practice Address - Country:US
Practice Address - Phone:805-544-8840
Practice Address - Fax:805-544-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7844235Z00000X
CA8314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty