Provider Demographics
NPI:1780117747
Name:BAY AREA SPEECHWORKS
Entity type:Organization
Organization Name:BAY AREA SPEECHWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-205-1754
Mailing Address - Street 1:131 CAMINO ALTO
Mailing Address - Street 2:SUITE E-3
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-205-1754
Mailing Address - Fax:
Practice Address - Street 1:131 CAMINO ALTO
Practice Address - Street 2:SUITE E-3
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2254
Practice Address - Country:US
Practice Address - Phone:415-205-1754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10040225X00000X
CA22812235Z00000X
CA15821235Z00000X
CA8306235Z00000X
CA13781235Z00000X
CA11013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty