Basic Information
| Provider Information | |||||||||
| NPI: | 1356589022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL COAST LANGUAGE AND LEARNING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 787 MUNRAS AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316457900 | ||||||||
| FaxNumber: | 8316457906 | ||||||||
| Practice Location | |||||||||
| Address1: | 787 MUNRAS AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316457900 | ||||||||
| FaxNumber: | 8316457906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | D'ATTILIO | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, SPEECH AND LANGUAGE | ||||||||
| AuthorizedOfficialTelephone: | 8316457900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | SP13025 | CA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.