Provider Demographics
NPI:1922855303
Name:SPEECH LANGUAGE AND LEARNING SERVICES OF NORTHERN CALIFORNIA, LLC
Entity type:Organization
Organization Name:SPEECH LANGUAGE AND LEARNING SERVICES OF NORTHERN CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JOHAN
Authorized Official - Last Name:VEJBY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:707-292-6303
Mailing Address - Street 1:310 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9422
Mailing Address - Country:US
Mailing Address - Phone:707-292-6303
Mailing Address - Fax:
Practice Address - Street 1:310 TILTON RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9422
Practice Address - Country:US
Practice Address - Phone:707-292-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech