MEDICARE: BALIAN SPEECH AND LANGUAGE THERAPY AND DIAGNOSTICS

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	252Y00000X	Early Intervention Provider Agency	SP 20809	CA

General Provider Information

NPI Number	:	1952731598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALIAN SPEECH AND LANGUAGE THERAPY AND DIAGNOSTICS

Provider Business Mailing Address
First Line	:	1011 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2646
Country	:	US
Telephone Number	:	818-434-5120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2646
Country	:	US
Telephone Number	:	818-434-5120
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	LUSINE BALIAN
Credential	:	M.S. CCC-SLP
Telephone Number	:	818-434-5120

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	05/25/2014

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Directions to “BALIAN SPEECH AND LANGUAGE THERAPY AND DIAGNOSTICS ” Practice Location

Language	Start Address	Practice Location

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