Provider Demographics
NPI:1043060163
Name:NEURAL PATHWAYS SPEECH THERAPY INC
Entity type:Organization
Organization Name:NEURAL PATHWAYS SPEECH THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH LAIS
Authorized Official - Middle Name:OPENA
Authorized Official - Last Name:TIJIBOY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:510-857-6554
Mailing Address - Street 1:8484 SUN BERRY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1260
Mailing Address - Country:US
Mailing Address - Phone:510-857-6554
Mailing Address - Fax:
Practice Address - Street 1:8484 SUN BERRY CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1260
Practice Address - Country:US
Practice Address - Phone:510-857-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty