Provider Demographics
NPI:1124434261
Name:EASY SPEECH PATHOLOGY, INC.
Entity type:Organization
Organization Name:EASY SPEECH PATHOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:442-282-6695
Mailing Address - Street 1:75100 MEDITERRANEAN
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9069
Mailing Address - Country:US
Mailing Address - Phone:760-837-0033
Mailing Address - Fax:760-837-1013
Practice Address - Street 1:75100 MEDITERRANEAN
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9069
Practice Address - Country:US
Practice Address - Phone:760-837-0033
Practice Address - Fax:760-837-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QM1300X
CA14513261QH0700X
CA18387261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech