Healthcare Provider Details

I. General information

NPI: 1306550660
Provider Name (Legal Business Name): CHLOE WAITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N JACKSON ST
GLENDALE CA
91206-4380
US

IV. Provider business mailing address

11818 RIVERSIDE DR APT 230
VALLEY VILLAGE CA
91607-4087
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-3111
  • Fax:
Mailing address:
  • Phone: 214-498-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: