Healthcare Provider Details

I. General information

NPI: 1134037799
Provider Name (Legal Business Name): SHAPE OF SOUND SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 VANALDEN AVE UNIT 108
NORTHRIDGE CA
91324-3701
US

IV. Provider business mailing address

9000 VANALDEN AVE UNIT 108
NORTHRIDGE CA
91324-3701
US

V. Phone/Fax

Practice location:
  • Phone: 818-913-5334
  • Fax: 818-913-5334
Mailing address:
  • Phone:
  • 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: ANNA NAZARYAN
Title or Position: CEO/SLP
Credential:
Phone: 818-913-5334