Provider Demographics
NPI:1730377433
Name:CROSS SPEECH AND LANGUAGE CENTER
Entity type:Organization
Organization Name:CROSS SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC
Authorized Official - Phone:805-733-4542
Mailing Address - Street 1:1133 N H ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3368
Mailing Address - Country:US
Mailing Address - Phone:805-733-4542
Mailing Address - Fax:805-733-4392
Practice Address - Street 1:1133 N H ST
Practice Address - Street 2:SUITE I
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3368
Practice Address - Country:US
Practice Address - Phone:805-733-4542
Practice Address - Fax:805-733-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSP000390Medicaid
CAZZZ05144ZOtherBLUE SHIELD PROVNUM