NPIMap

Organization Active NPI

Speech Pathology Services of Marin Sonoma Incorportated

  • Speech-Language Pathologist
  • Petaluma, CA
National Provider Identifier
1801019773
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
SPEECH PATHOLOGY SERVICES OF MARIN SONOMA INCORPORTATED
Practice address
1301 Redwood Way
Suite 165
Petaluma, CA 94954-1107
Phone
(707) 763-6419
Fax
(707) 763-2537
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Elaine Stevick, M.A C.C.C.SLPNPI 1043366198
Title
Ceo Clinical Director
Phone
(707) 763-6419

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

1301 Redwood Way
Suite 165
Petaluma, CA 94954-1107

Mailing address

1301 Redwood Way
Suite 165
Petaluma, CA 94954-1107
Phone (707) 763-6419

National Provider Directory

National Provider Directory
Tax ID family
Speech Pathology Services of Marin Sonoma Incorporated2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1301 Redwood Way
Ste 165
Petaluma, CA 94954
Phone (707) 763-6419

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801019773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 REDWOOD WAY",
            "address_2": "SUITE 165",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541107",
            "telephone_number": "707-763-6419",
            "fax_number": "707-763-2537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 REDWOOD WAY",
            "address_2": "SUITE 165",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949541107",
            "telephone_number": "707-763-6419",
            "fax_number": "707-763-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEECH PATHOLOGY SERVICES OF MARIN SONOMA INCORPORTATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEVICK",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "CEO CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "707-763-6419",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.A C.C.C.SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.