Healthcare Provider Details

I. General information

NPI: 1104796747
Provider Name (Legal Business Name): PATHWAYS TO PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W OLIVE AVE
MONROVIA CA
91016-7117
US

IV. Provider business mailing address

3552 S GILES AVE UNIT 1S
CHICAGO IL
60653-1160
US

V. Phone/Fax

Practice location:
  • Phone: 626-538-7181
  • Fax:
Mailing address:
  • Phone: 626-538-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN PARKER
Title or Position: DIRECTOR
Credential:
Phone: 626-538-7181