Provider Demographics
NPI:1598164261
Name:THE GIFT OF SPEECH, A PROFESSIONAL SPEECH-LANGUAGE PATHOLOGY CORPORATI
Entity type:Organization
Organization Name:THE GIFT OF SPEECH, A PROFESSIONAL SPEECH-LANGUAGE PATHOLOGY CORPORATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULRICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-952-2588
Mailing Address - Street 1:3031 W MARCH LN
Mailing Address - Street 2:SUITE 217 WEST
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3031 W MARCH LN
Practice Address - Street 2:SUITE 217 WEST
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6500
Practice Address - Country:US
Practice Address - Phone:209-952-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA9682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty