Provider Demographics
NPI:1831412576
Name:FOOTHILLS SPEECH & LANGUAGE, INC.
Entity type:Organization
Organization Name:FOOTHILLS SPEECH & LANGUAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC
Authorized Official - Phone:916-351-5991
Mailing Address - Street 1:90 BLUE RAVINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4729
Mailing Address - Country:US
Mailing Address - Phone:916-351-5991
Mailing Address - Fax:916-351-5786
Practice Address - Street 1:90 BLUE RAVINE RD STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4729
Practice Address - Country:US
Practice Address - Phone:916-351-5991
Practice Address - Fax:916-351-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty