NPIMap

Organization Active NPI

Collab Pediatric Clinic, a Speech Therapy Corporation

Doing business as Collab Pediatric Clinic

  • Speech-Language Pathologist
  • West Covina, CA
National Provider Identifier
1932829934
Registry record updated Jan 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
COLLAB PEDIATRIC CLINIC, A SPEECH THERAPY CORPORATION
Doing business as
Collab Pediatric Clinic
Practice address
3252 Gabriella St
West Covina, CA 91792-2101
Phone
(626) 252-0941
NPI assigned
Aug 30, 2022
Last updated
Jan 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2024

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

Authorized official

Name
Justin Wu, CCC-SLPNPI 1821620089
Title
Co-Owner
Phone
(626) 739-8775

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X NU Primary
Hearing and Speech Clinic/Center 261QH0700X NU

Addresses

Primary practice location

3252 Gabriella St
West Covina, CA 91792-2101

Mailing address

3252 Gabriella St
West Covina, CA 91792-2101
Phone (626) 252-0941

Other names 1

  • Collab Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705190400000",
    "number": "1932829934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3252 GABRIELLA ST",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917922101",
            "telephone_number": "626-252-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3252 GABRIELLA ST",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917922101",
            "telephone_number": "626-252-0941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLAB PEDIATRIC CLINIC, A SPEECH THERAPY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-30",
        "last_updated": "2024-01-14",
        "certification_date": "2024-01-14",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "626-739-8775",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collab Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.