Organization
SAN DIEGO STATE UNIVERSITY
Active
Parent organization
SAN DIEGO STATE UNIVERSITY
Other names
San Diego State University Speech, Language and Hearing Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN DIEGO STATE UNIVERSITY
Authorized official
AGNES WONG NICKERSON (ASSOCIATE VP OF FINANCIAL OPERATION)
(619) 594-6017
Entity
Organization
Contact information
Practice address
5500 CAMPANILE DR, SAN DIEGO, CA 92182-1518
(619) 594-7747
(619) 594-5917
Mailing address
5500 CAMPANILE DR, SAN DIEGO, CA 92182-1518
(619) 594-7747
(619) 594-5917
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
—
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Enumeration date
03/11/2016
Last updated
03/11/2016
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