Provider Demographics
NPI:1154875912
Name:THERAPEUTIC LANGUAGE CLINIC. INC.
Entity type:Organization
Organization Name:THERAPEUTIC LANGUAGE CLINIC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:916-541-8239
Mailing Address - Street 1:10349 DANIEL WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2004
Mailing Address - Country:US
Mailing Address - Phone:916-541-8239
Mailing Address - Fax:
Practice Address - Street 1:9813 FAIR OAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7012
Practice Address - Country:US
Practice Address - Phone:916-541-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGNB32016-02245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty