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Organization
TUSTIN SPEECH THERAPY, INC.
Active
Organization
TUSTIN SPEECH THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KYMRY HART FOWLER MA, CCC, SLP (PRESIDENT)
(714) 838-2853
Entity
Organization
Contact information
Practice address
661 WEST FIRST STREET, SUITE E, TUSTIN, CA 92780
(714) 838-2853
(714) 838-4533
Mailing address
30 PARMA, IRVINE, CA 92602
(714) 730-4859
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP 10386
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09116318
ASHA CCC-SLP
CA
01
—
SP 10386
STATE OF CALIFORNIA - DCA - SPEECH/LANGUAGE PATHOLOGY LICENSE
CA
Enumeration date
09/07/2016
Last updated
09/07/2016
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