NPIMap

Organization Active NPI

Avid Speech Therapy

  • Speech-Language Pathologist
  • Fountain Valley, CA
National Provider Identifier
1942851316
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
AVID SPEECH THERAPY
Practice address
10061 Talbert Ave Ste 104
Fountain Valley, CA 92708-5159
Phone
(714) 272-3090
Fax
(714) 849-5393
NPI assigned
Sep 26, 2019
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Authorized official

Name
Narissa Ventress, M.A. CCC-SLPNPI 1265870471
Title
Ceo
Phone
(714) 642-5420

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 Assistant 2355S0801X
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

10061 Talbert Ave Ste 104
Fountain Valley, CA 92708-5159

Mailing address

10061 Talbert Ave Ste 104
Fountain Valley, CA 92708-5159
Phone (714) 272-3090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240102001131 CA Part B Supplier - Clinic/Group Practice 7618327743 Receives reassigned benefits from 1 practitioner
Practice locations: Fountain Valley, CA

National Provider Directory

National Provider Directory

Locations

10061 Talbert Ave
Ste 104
Fountain Valley, CA 92708
Phone (714) 272-3090

18396 Brookhurst St
Fountain Valley, CA 92708
Phone (714) 642-5420

Practitioners & affiliated clinicians

Practitioners 12

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": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1942851316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10061 TALBERT AVE STE 104",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085159",
            "telephone_number": "714-272-3090",
            "fax_number": "714-849-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10061 TALBERT AVE STE 104",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085159",
            "telephone_number": "714-272-3090",
            "fax_number": "714-849-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVID SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "VENTRESS",
        "authorized_official_first_name": "NARISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-642-5420",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.