Healthcare Provider Details

I. General information

NPI: 1700758034
Provider Name (Legal Business Name): SPEECH BUDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 LOUELLA AVE
VENICE CA
90291-4014
US

IV. Provider business mailing address

2017 LOUELLA AVE
VENICE CA
90291-4014
US

V. Phone/Fax

Practice location:
  • Phone: 323-696-6118
  • Fax:
Mailing address:
  • Phone: 323-696-6118
  • 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: SHIR LAVIAN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 818-414-7006