Provider Demographics
NPI:1962895532
Name:WINGS SPEECH AND LANGUAGE CENTER INC
Entity type:Organization
Organization Name:WINGS SPEECH AND LANGUAGE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BENES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:909-390-1313
Mailing Address - Street 1:1500 S HAVEN AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2969
Mailing Address - Country:US
Mailing Address - Phone:909-390-1313
Mailing Address - Fax:909-390-1311
Practice Address - Street 1:1500 S HAVEN AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2969
Practice Address - Country:US
Practice Address - Phone:909-390-1313
Practice Address - Fax:909-390-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty