Provider Demographics
NPI:1871331421
Name:MENLO SPEECH PATHOLOGY INC.
Entity type:Organization
Organization Name:MENLO SPEECH PATHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCCC-SLP
Authorized Official - Phone:650-714-9459
Mailing Address - Street 1:648 MENLO AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4713
Mailing Address - Country:US
Mailing Address - Phone:650-714-9459
Mailing Address - Fax:
Practice Address - Street 1:648 MENLO AVE STE 8
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4713
Practice Address - Country:US
Practice Address - Phone:650-714-9459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center