Provider Demographics
NPI:1124315221
Name:B EXPRESSIVE, INC.
Entity type:Organization
Organization Name:B EXPRESSIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:DEADWYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LIC MHSCCCSLP
Authorized Official - Phone:310-766-4747
Mailing Address - Street 1:6601 CENTER DR W
Mailing Address - Street 2:STE. #540
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1582
Mailing Address - Country:US
Mailing Address - Phone:310-766-4747
Mailing Address - Fax:310-337-1379
Practice Address - Street 1:6601 CENTER DR W
Practice Address - Street 2:STE. #540
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1582
Practice Address - Country:US
Practice Address - Phone:310-766-4747
Practice Address - Fax:310-337-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8247261QH0700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty