Healthcare Provider Details

I. General information

NPI: 1003584970
Provider Name (Legal Business Name): MY EDUCATION ALLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S LOS ROBLES AVE STE 104
PASADENA CA
91101-3616
US

IV. Provider business mailing address

260 S LOS ROBLES AVE STE 104
PASADENA CA
91101-3616
US

V. Phone/Fax

Practice location:
  • Phone: 626-206-0444
  • Fax:
Mailing address:
  • Phone: 626-206-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER STROM
Title or Position: PRESIDENT
Credential:
Phone: 626-375-2085