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General NPI Number Information
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NPI Number | 1134617954
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Entity Type | Individual
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Provider Name | MARIYA GORELIK MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 580 S SAN VICENTE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-4621
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Country | US
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Telephone | 323-782-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 12160 HART ST APT 308
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-5851
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Country | US
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Telephone | 818-620-9212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP26152
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License Number State | CA
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