MEDICARE: MISS MEGAN GRAHAM AVILA M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 18486	CA

General Provider Information

NPI Number	:	1326307315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGAN GRAHAM AVILA M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	3521 LOMITA BLVD
Second Line	:	SUITE 201
City	:	TORRANCE
State	:	CA
Zip	:	90505-5039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 LOMITA BLVD
Second Line	:	SUITE 201
City	:	TORRANCE
State	:	CA
Zip	:	90505-5039
Country	:	US
Telephone Number	:	310-856-8528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	05/10/2012

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Directions to “ MISS MEGAN GRAHAM AVILA M.A. CCC-SLP” Practice Location

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