Organization
GNOODLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BISHOP MS (EXECUTIVE DIRECTOR)
(775) 354-9706
Entity
Organization
Contact information
Practice address
5460 SKYLANE BLVD STE C, SANTA ROSA, CA 95403-1793
(775) 354-9706
Mailing address
422 LARKFIELD CTR # 310, SANTA ROSA, CA 95403-1408
(775) 354-9706
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
11/30/2021
Last updated
11/30/2021
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