Provider Demographics
NPI:1104621846
Name:HERITAGE SPEECH THERAPY
Entity type:Organization
Organization Name:HERITAGE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-771-5881
Mailing Address - Street 1:1524 BROOKHOLLOW DR STE A100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5426
Mailing Address - Country:US
Mailing Address - Phone:949-771-5881
Mailing Address - Fax:
Practice Address - Street 1:1524 BROOKHOLLOW DR STE A100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5426
Practice Address - Country:US
Practice Address - Phone:949-771-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech