Provider Demographics
NPI:1730863168
Name:CEREBROLINGUA SPEECH-LANGUAGE PATHOLOGY, PC
Entity type:Organization
Organization Name:CEREBROLINGUA SPEECH-LANGUAGE PATHOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:760-685-4414
Mailing Address - Street 1:6019 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1851
Mailing Address - Country:US
Mailing Address - Phone:760-685-4144
Mailing Address - Fax:
Practice Address - Street 1:6019 8TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1851
Practice Address - Country:US
Practice Address - Phone:760-685-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation