Provider Demographics
NPI:1538592746
Name:MORGAN HILL SPEECH AND MYOFUNCTIONAL THERAPY
Entity type:Organization
Organization Name:MORGAN HILL SPEECH AND MYOFUNCTIONAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RIZQALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:408-612-8877
Mailing Address - Street 1:605 TENNANT AVE STE I
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5529
Mailing Address - Country:US
Mailing Address - Phone:408-612-8877
Mailing Address - Fax:408-762-3648
Practice Address - Street 1:605 TENNANT AVE STE I
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5529
Practice Address - Country:US
Practice Address - Phone:408-612-8877
Practice Address - Fax:408-762-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA436032OtherKAISER PERMANENTE NORTHERN REGION