Provider Demographics
NPI:1316160286
Name:SPEECH PATHOLOGY SERVICES OF MARIN SONOMA INCORPORATED
Entity type:Organization
Organization Name:SPEECH PATHOLOGY SERVICES OF MARIN SONOMA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP
Authorized Official - Phone:415-479-7880
Mailing Address - Street 1:30 N SAN PEDRO RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4118
Mailing Address - Country:US
Mailing Address - Phone:415-479-7880
Mailing Address - Fax:415-479-7889
Practice Address - Street 1:30 N SAN PEDRO RD
Practice Address - Street 2:SUITE 265
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4118
Practice Address - Country:US
Practice Address - Phone:415-479-7880
Practice Address - Fax:415-479-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty