Provider Demographics
NPI:1053010124
Name:JACLYN CRUZ SPEECH LANGUAGE THERAPY, INC. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JACLYN CRUZ SPEECH LANGUAGE THERAPY, INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-363-0251
Mailing Address - Street 1:13658 HAWTHORNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5822
Mailing Address - Country:US
Mailing Address - Phone:310-363-0251
Mailing Address - Fax:
Practice Address - Street 1:13658 HAWTHORNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5822
Practice Address - Country:US
Practice Address - Phone:310-363-0251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty