Provider Demographics
NPI:1285241398
Name:SIGNATURE SPEECH THERAPY SERVICES CORPORATION
Entity type:Organization
Organization Name:SIGNATURE SPEECH THERAPY SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:757-289-7763
Mailing Address - Street 1:6320 CANOGA AVE FL 15
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2563
Mailing Address - Country:US
Mailing Address - Phone:818-312-5313
Mailing Address - Fax:
Practice Address - Street 1:6320 CANOGA AVE FL 15
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2563
Practice Address - Country:US
Practice Address - Phone:818-312-5313
Practice Address - Fax:833-358-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty