Provider Demographics
NPI:1699953539
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:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:209-952-2588
Mailing Address - Street 1:4719 QUAIL LAKES DR
Mailing Address - Street 2:#G240
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:209-952-2588
Mailing Address - Fax:209-952-2544
Practice Address - Street 1:3031 W MARCH LN
Practice Address - Street 2:SUITE 117 S
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:209-952-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSP000680Medicaid