MEDICARE: PATHWAYS SPEECH & LANGUAGE PATHOLOGY, INC

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	2635	CA

General Provider Information

NPI Number	:	1770741712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS SPEECH & LANGUAGE PATHOLOGY, INC

Provider Business Mailing Address
First Line	:	3205 OCEAN PARK BLVD
Second Line	:	SUITE # 120
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3224
Country	:	US
Telephone Number	:	310-581-6430
Fax Number	:	310-581-6433

Provider Business Practice Location Address
First Line	:	3205 OCEAN PARK BLVD
Second Line	:	SUITE # 120
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3224
Country	:	US
Telephone Number	:	310-581-6430
Fax Number	:	310-581-6433

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. GAYLE E. KEEFER
Credential	:	M.A.
Telephone Number	:	310-581-6430

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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