Provider Demographics
NPI:1063150910
Name:THRIVE SPEECH THERAPY
Entity type:Organization
Organization Name:THRIVE SPEECH THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:KATHARINE
Authorized Official - Last Name:FAIRBAIRN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:424-225-1481
Mailing Address - Street 1:732 VIA DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1612
Mailing Address - Country:US
Mailing Address - Phone:818-324-2292
Mailing Address - Fax:
Practice Address - Street 1:3858 W CARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6705
Practice Address - Country:US
Practice Address - Phone:424-225-1481
Practice Address - Fax:424-251-5380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIVE SPEECH & FEEDING THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-21
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty