Mid Peninsula Speech and Language Clinic

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2651 Issued in CA

Legal business name

MID PENINSULA SPEECH AND LANGUAGE CLINIC

Practice address

102 Ferne Ave.
Palo Alto, CA 94306-4644

Phone

(650) 380-4929

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Donna Jo Dagenais, M.A. C.C.C.NPI 1770326415

Title

Director

Phone

(650) 380-4929

Specialties & licenses 1

Addresses

Other names 1

• MPSLC Other name

Locations

Practitioners 1

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

• Donna Jo Dagenais, MA, CCC-SP

  • Speech-Language Pathologist
  • Palo Alto, CA
  • NPI 1770326415
  NPD Authorized official

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1780702001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 MIDDLEFIELD RD. #558",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943062516",
            "telephone_number": "650-321-8111",
            "fax_number": "650-321-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 FERNE AVE.",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943064644",
            "telephone_number": "650-380-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID PENINSULA SPEECH AND LANGUAGE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "DAGENAIS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "650-380-4929",
        "authorized_official_credential": "M.A. C.C.C."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "2651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MPSLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brittni Mae Micham, M.D.
• Michelle a Demarta DMD Inc
• Michelle Graca Medeiros
• Michelle Haghpanah D.D.S., M.P.H., P.C.
• Gabriele Jessica Mickevicius, PT
• Mid-Peninsula Eating Disorder Clinic, a Marriage and Family Therapy Co
• Midpen Resident Services
• Bethel Roba Mieso, MD
• Riley Mihelich
• Chantal Nathalie Mihm, PSY.D.

• Speech-Language Pathologist in Palo Alto, CA
• Providers in Palo Alto, 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 Jun 20, 2024; 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.