Provider Demographics
NPI:1124689294
Name:FOLSOM ADVANCED SPEECH THERAPY
Entity type:Organization
Organization Name:FOLSOM ADVANCED SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANIESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-673-4455
Mailing Address - Street 1:555 OAKDALE ST STE F
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2451
Mailing Address - Country:US
Mailing Address - Phone:775-673-4455
Mailing Address - Fax:775-673-4457
Practice Address - Street 1:555 OAKDALE ST STE F
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2451
Practice Address - Country:US
Practice Address - Phone:775-673-4455
Practice Address - Fax:775-673-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty