Provider Demographics
NPI:1366077083
Name:ODYSSEY SPEECH THERAPY, INC
Entity type:Organization
Organization Name:ODYSSEY SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:909-734-5373
Mailing Address - Street 1:25370 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2323
Mailing Address - Country:US
Mailing Address - Phone:909-734-5373
Mailing Address - Fax:
Practice Address - Street 1:25370 PARK AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2323
Practice Address - Country:US
Practice Address - Phone:909-734-5373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty