Provider Demographics
NPI:1801241583
Name:LV SPEECH THERAPY GROUP, INC.
Entity type:Organization
Organization Name:LV SPEECH THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-0912
Mailing Address - Street 1:3620 LONG BEACH BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-6014
Mailing Address - Country:US
Mailing Address - Phone:310-930-7491
Mailing Address - Fax:
Practice Address - Street 1:3620 LONG BEACH BLVD STE A1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6014
Practice Address - Country:US
Practice Address - Phone:310-930-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty