Tustin Speech Therapy, Inc.

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP 10386 Issued in CA

Legal business name

TUSTIN SPEECH THERAPY, INC.

Practice address

661 West First Street
Suite E
Tustin, CA 92780

Phone

(714) 838-2853

Fax

(714) 838-4533

NPI assigned

Sep 7, 2016

Organization subpart

No

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

Authorized official

Name

Ms. Kymry Hart Fowler, MA, CCC, SLP

Title

President

Phone

(714) 838-2853

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Tustin Speech Therapy Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Tustin Speech Therapy Inc.

  • Rehabilitation Clinic/Center
  • Tustin, CA
  • NPI 1952712655
  NPD tax ID
• Tustin Speech Therapy, Inc

  • Hearing and Speech Clinic/Center
  • Tustin, CA
  • NPI 1235532599
  NPD tax ID
• Tustin Speech Therapy, Inc

  • Speech-Language Pathologist
  • Tustin, CA
  • NPI 1306257548
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Evensen, M.S., SLP

  • Speech-Language Pathologist
  • Irvine, CA
  • NPI 1417491473
  NPD (past)

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473206400000",
    "number": "1437606555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PARMA",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92602",
            "telephone_number": "714-730-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 WEST FIRST STREET",
            "address_2": "SUITE E",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "92780",
            "telephone_number": "714-838-2853",
            "fax_number": "714-838-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUSTIN SPEECH THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "KYMRY",
        "authorized_official_middle_name": "HART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-838-2853",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, CCC, SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP 10386",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA CCC-SLP",
            "identifier": "09116318",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CALIFORNIA - DCA - SPEECH/LANGUAGE PATHOLOGY LICENSE",
            "identifier": "SP 10386",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tustin Speech Therapy Inc.
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• Tustin Teleradiology Medical Group Inc.
• Tustin Unified School District
• Tustin Urgent Care, Apc (Xpress Urgent Care Tustin)
• Ranko Savic Tutulugdzija, L.A.
• UC Irvine Health - Dept. of Dermatology

• Speech-Language Pathologist in Tustin, CA
• Providers in Tustin, 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 Sep 7, 2016; 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.