Organization Name: | NINETTE FONSECA-CHICCA MS SPEECH AND LANGUAGE PATHOLOGIST-CCC A PROFES |
NPI Number: | 1134453178 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NINETTE FONSECA CHICCA (PRESIDENT/SPEECH PATHOLOGIST) |
Mailing Address: | 1295 Petaluma Blvd N Ste 5 Petaluma |
State: | CA US |
Postal Code: | 949526530 |
Phone Number: | 7073646075 |
Fax Number: | 7077955709 |
NPI Enumeration Date: | 09/23/2009 |
NPI Last Update Date: | 12/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP17198 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |