Healthcare Provider Details

I. General information

NPI: 1700606100
Provider Name (Legal Business Name): WONDER TALK SPEECH AND LANGUAGE THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 W MANCHESTER AVE STE 203
LOS ANGELES CA
90045-4266
US

IV. Provider business mailing address

6060 W MANCHESTER AVE STE 203
LOS ANGELES CA
90045-4266
US

V. Phone/Fax

Practice location:
  • Phone: 310-776-5259
  • Fax:
Mailing address:
  • Phone: 310-776-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHELLE MINKYUNG LEE
Title or Position: DIRECT, SPEECH-LANGUAGE PATHOLOGIST
Credential: MS
Phone: 909-518-1968