Provider Demographics
NPI:1679691703
Name:LIFE SPIRIT SPEECH PATHOLOGY INC
Entity type:Organization
Organization Name:LIFE SPIRIT SPEECH PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:949-842-9557
Mailing Address - Street 1:26284 OSO RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1629
Mailing Address - Country:US
Mailing Address - Phone:949-842-9557
Mailing Address - Fax:
Practice Address - Street 1:26284 OSO RD
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1629
Practice Address - Country:US
Practice Address - Phone:949-842-9557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty