Provider Demographics
NPI:1386975233
Name:LOS ANGELES SPEECH AND LANGUAGE THERAPY CENTER INC
Entity type:Organization
Organization Name:LOS ANGELES SPEECH AND LANGUAGE THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT/SLP
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:310-649-6199
Mailing Address - Street 1:5761 BUCKINGHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6515
Mailing Address - Country:US
Mailing Address - Phone:310-649-6199
Mailing Address - Fax:310-649-5597
Practice Address - Street 1:5761 BUCKINGHAM PKWY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6515
Practice Address - Country:US
Practice Address - Phone:310-649-6199
Practice Address - Fax:310-649-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSP000290OtherMEDI-CAL