Provider Demographics
NPI:1740992015
Name:SEED AND SOIL SPEECH-LANGUAGE PATHOLOGY INC.
Entity type:Organization
Organization Name:SEED AND SOIL SPEECH-LANGUAGE PATHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-771-8605
Mailing Address - Street 1:19698 MOUNTAIN MDW N
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8543
Mailing Address - Country:US
Mailing Address - Phone:909-771-8605
Mailing Address - Fax:
Practice Address - Street 1:19698 MOUNTAIN MDW N
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8543
Practice Address - Country:US
Practice Address - Phone:909-771-8605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty