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General NPI Number Information
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NPI Number | 1265663900
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Entity Type | Organization
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Legal Business Name | SMILE PEDIATRIC SPEECH THERAPY & DIAGNOSTICS INC.
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 3031 BEVERLY BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90057-1013
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Country | US
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Telephone | 323-747-5055
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Fax | 213-483-8537
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Provider Business Mailing Address
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Address Line | 1639 WATERLOO ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-2422
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Country | US
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Telephone | 323-747-5055
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Fax | 213-483-8537
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | DANIELLE NICOLE HAJJAR
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Credential | M.S. CCC-SLP
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Telephone | 323-747-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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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 | 14510
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License Number State | CA
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