Provider Demographics
NPI:1366578627
Name:SAN DIEGO KIDSPEAK LLC
Entity type:Organization
Organization Name:SAN DIEGO KIDSPEAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTER-MARGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC
Authorized Official - Phone:619-838-4566
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-0773
Mailing Address - Country:US
Mailing Address - Phone:619-838-4566
Mailing Address - Fax:
Practice Address - Street 1:8813 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE 2002
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1937
Practice Address - Country:US
Practice Address - Phone:619-838-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty