Basic Information
| Provider Information | |||||||||
| NPI: | 1073874764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APPLIED SPEECH COMMUNICATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3117 MCHENRY AVE STE B | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095441032 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Practice Location | |||||||||
| Address1: | 3117 MCHENRY AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095441032 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2012 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | GASKELL | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2095441032 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCC-SLP.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12114980 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.