Provider Demographics
NPI:1457930216
Name:RAVEN SPEECH THERAPY
Entity Type:Organization
Organization Name:RAVEN SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOA
Authorized Official - Middle Name:MAISHA
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:714-588-3637
Mailing Address - Street 1:PO BOX 9124
Mailing Address - Street 2:
Mailing Address - City:CEDARPINES PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92322-9124
Mailing Address - Country:US
Mailing Address - Phone:714-588-3637
Mailing Address - Fax:
Practice Address - Street 1:21733 VISTA RD
Practice Address - Street 2:
Practice Address - City:CEDARPINES PARK
Practice Address - State:CA
Practice Address - Zip Code:92322-9232
Practice Address - Country:US
Practice Address - Phone:714-588-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty