Provider Demographics
NPI:1588342455
Name:COSMIC SPEECH THERAPY PC
Entity type:Organization
Organization Name:COSMIC SPEECH THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:MALKA
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:818-527-5576
Mailing Address - Street 1:9101 TOPANGA CANYON BLVD APT 239
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5764
Mailing Address - Country:US
Mailing Address - Phone:818-527-5576
Mailing Address - Fax:
Practice Address - Street 1:9700 RESEDA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5504
Practice Address - Country:US
Practice Address - Phone:818-527-5576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty