Basic Information
| Provider Information | |||||||||
| NPI: | 1881167237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASY SPEECH THERAPY CENTER | ||||||||
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| Address1: | 4632 ESPY ST | ||||||||
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| City: | SESSER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628842269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185133394 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41555 COOK ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922115184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608370033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2019 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | LINDSAY | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | JANE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6185133394 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS, CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.