Provider Demographics
NPI:1134820525
Name:AUTHENTICITY SPEECH AND LANGUAGE THERAPY, INC.
Entity type:Organization
Organization Name:AUTHENTICITY SPEECH AND LANGUAGE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:908-672-6699
Mailing Address - Street 1:4452 37TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4663
Mailing Address - Country:US
Mailing Address - Phone:908-672-6699
Mailing Address - Fax:
Practice Address - Street 1:4452 37TH ST APT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4663
Practice Address - Country:US
Practice Address - Phone:908-672-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech