Ivy League Speech Therapy Center

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

IVY LEAGUE SPEECH THERAPY CENTER

Practice address

309 Cherry LN
Manteca, CA 95337-4312

Phone

(516) 425-9897

NPI assigned

May 1, 2023

Last updated

May 1, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda Emma Tavella, M.A. CCC-SLPNPI 1639326655

Title

Ceo

Phone

(516) 425-9897

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Linda Emma Tavella

  • Speech-Language Pathologist
  • Merrick, NY
  • NPI 1639326655
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1154019842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 CHERRY LN",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953374312",
            "telephone_number": "516-425-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 CHERRY LN",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953374312",
            "telephone_number": "516-425-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY LEAGUE SPEECH THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-01",
        "last_updated": "2023-05-01",
        "certification_date": "2023-04-29",
        "status": "A",
        "authorized_official_last_name": "TAVELLA",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "EMMA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "516-425-9897",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Manteca, CA
• Providers in Manteca, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.