Provider Demographics
NPI:1104556570
Name:SANTA ROSA SPEECH THERAPY, PC
Entity type:Organization
Organization Name:SANTA ROSA SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH LANGUAGE PATHOLOGI
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:707-547-7630
Mailing Address - Street 1:6733 LAVON CT
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9411
Mailing Address - Country:US
Mailing Address - Phone:707-547-7630
Mailing Address - Fax:
Practice Address - Street 1:1212 COLLEGE AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3977
Practice Address - Country:US
Practice Address - Phone:707-547-7630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA ROSA SPEECH THERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-16
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty