Basic Information
| Provider Information | |||||||||
| NPI: | 1124434261 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EASY SPEECH PATHOLOGY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EASY SPEECH THERAPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75100 MEDITERRANEAN | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922119069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Practice Location | |||||||||
| Address1: | 75100 MEDITERRANEAN | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922119069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
| FaxNumber: | 7608371013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHAMPAGNE | ||||||||
| AuthorizedOfficialFirstName: | ASHLYN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7603409832 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MCD, CCC-SLP | ||||||||
| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.