Provider Demographics
NPI:1487342093
Name:FREEDMAN, AVITAL MIRIAM (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:AVITAL
Middle Name:MIRIAM
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N POINSETTIA PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1926
Mailing Address - Country:US
Mailing Address - Phone:323-395-4581
Mailing Address - Fax:
Practice Address - Street 1:2836 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2126
Practice Address - Country:US
Practice Address - Phone:323-522-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist