Provider Demographics
NPI:1104158252
Name:WINN SPEECH PATHOLOGY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WINN SPEECH PATHOLOGY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-375-2332
Mailing Address - Street 1:11 RANCHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2433
Mailing Address - Country:US
Mailing Address - Phone:310-375-2332
Mailing Address - Fax:310-378-4028
Practice Address - Street 1:11 RANCHVIEW RD
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2433
Practice Address - Country:US
Practice Address - Phone:310-375-2332
Practice Address - Fax:310-378-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty