Healthcare Provider Details

I. General information

NPI: 1952731598
Provider Name (Legal Business Name): BALIAN SPEECH AND LANGUAGE THERAPY AND DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W GLENOAKS BLVD
GLENDALE CA
91202-2646
US

IV. Provider business mailing address

1011 W GLENOAKS BLVD
GLENDALE CA
91202-2646
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-5120
  • Fax:
Mailing address:
  • Phone: 818-434-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSP 20809
License Number StateCA

VIII. Authorized Official

Name: LUSINE BALIAN
Title or Position: SPEECH PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 818-434-5120