Provider Demographics
NPI:1740539493
Name:SPEECH GOALS SPEECH THERAPY INC.
Entity type:Organization
Organization Name:SPEECH GOALS SPEECH THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JASNA
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:650-438-4631
Mailing Address - Street 1:363 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5980
Mailing Address - Country:US
Mailing Address - Phone:650-583-3797
Mailing Address - Fax:650-583-3797
Practice Address - Street 1:363 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5980
Practice Address - Country:US
Practice Address - Phone:650-583-3797
Practice Address - Fax:650-583-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty