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General NPI Number Information
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NPI Number | 1386796340
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Entity Type | Individual
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Provider Name | LISA KANNOF M.ED.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD SUITE 216
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 310-429-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 548 11TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90402-2902
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Country | US
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Telephone | 310-394-4335
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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 | SP 3275
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License Number State | CA
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