Healthcare Provider Details

I. General information

NPI: 1619781598
Provider Name (Legal Business Name): DYSPHAGIA SOLUTIONS LA SPEECH PATHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARDIFF AVENUE
LOS ANGELES CA
90035
US

IV. Provider business mailing address

324 S BEVERLY DR # 1126
BEVERLY HILLS CA
90212-4822
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-8439
  • Fax:
Mailing address:
  • Phone: 818-456-8439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SASHA GROSSMAN
Title or Position: OWNER, SLP, ENDOSCOPIST
Credential: M.S., CCC-SLP
Phone: 323-910-2506