Provider Demographics
NPI:1336554260
Name:SEASIDE SPEECH THERAPY, INC
Entity type:Organization
Organization Name:SEASIDE SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-647-0177
Mailing Address - Street 1:1623 GOODYEAR AVE
Mailing Address - Street 2:STE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5804
Mailing Address - Country:US
Mailing Address - Phone:805-644-8255
Mailing Address - Fax:805-644-8256
Practice Address - Street 1:4562 WESTINGHOUSE ST STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5797
Practice Address - Country:US
Practice Address - Phone:805-644-8255
Practice Address - Fax:805-644-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21685235Z00000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty