| NPI | 1659989150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE MICHELLE BOHANNON Speech Language Pathologist 909-964-8086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-23 |