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General NPI Number Information
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NPI Number | 1184112757
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Entity Type | Organization
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Legal Business Name | GENERATION SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 04/28/2018
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Last Update Date | 04/28/2018
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Provider Practice Location Address
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Address Line | 11150 BERTRAND AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4005
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Country | US
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Telephone | 818-915-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 11150 BERTRAND AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGAUGE PATHOLOGIST
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Name | SHANNON BROUSSALIAN
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Credential | M.S., CCC-SLP
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Telephone | 818-915-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | CA
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