Provider Demographics
NPI:1962742700
Name:THE SUPERSPEECH & LANGUAGE CONNECTION LP
Entity type:Organization
Organization Name:THE SUPERSPEECH & LANGUAGE CONNECTION LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUGEBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:510-306-9066
Mailing Address - Street 1:2150 MARINER SQUARE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 MARINER SQUARE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1081
Practice Address - Country:US
Practice Address - Phone:510-306-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty