Provider Demographics
NPI:1356589071
Name:WINGS SPEECH AND LANGUAGE CENTER, INC
Entity type:Organization
Organization Name:WINGS SPEECH AND LANGUAGE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENES
Authorized Official - Suffix:
Authorized Official - Credentials:MC, SLP-CCC
Authorized Official - Phone:909-390-1313
Mailing Address - Street 1:4100 E. JURUPA ST.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761
Mailing Address - Country:US
Mailing Address - Phone:909-390-1313
Mailing Address - Fax:909-390-1311
Practice Address - Street 1:4100 E. JURUPA ST.
Practice Address - Street 2:SUITE 108
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:909-390-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16940302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization