Provider Demographics
NPI:1083442479
Name:SYLVAN SPEECH AND LANGUAGE THERAPY
Entity type:Organization
Organization Name:SYLVAN SPEECH AND LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, MS
Authorized Official - Phone:559-492-8189
Mailing Address - Street 1:3654 THORNTON AVE # 1061
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-7400
Mailing Address - Country:US
Mailing Address - Phone:559-492-8189
Mailing Address - Fax:
Practice Address - Street 1:33439 10TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587
Practice Address - Country:US
Practice Address - Phone:559-492-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech