Provider Demographics
NPI:1982001962
Name:EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CF-SLP
Authorized Official - Phone:714-743-1727
Mailing Address - Street 1:12062 VALLEY VIEW ST., SUITE 137
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-901-1518
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 137
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1741
Practice Address - Country:US
Practice Address - Phone:714-901-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty