Provider Demographics
NPI:1144643313
Name:ADVANCE SPEECH & LANGUAGE PROFESSIONAL SERVICES INC .
Entity type:Organization
Organization Name:ADVANCE SPEECH & LANGUAGE PROFESSIONAL SERVICES INC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:855-500-0525
Mailing Address - Street 1:PO BOX 890792
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-0792
Mailing Address - Country:US
Mailing Address - Phone:855-500-0525
Mailing Address - Fax:
Practice Address - Street 1:36060 VALENCIA WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-9029
Practice Address - Country:US
Practice Address - Phone:855-500-0525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty