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General NPI Number Information
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NPI Number | 1487342093
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Entity Type | Individual
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Provider Name | AVITAL MIRIAM FREEDMAN MS, SLP-CCC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 2836 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90026-2126
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Country | US
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Telephone | 323-522-6071
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Fax |
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Provider Business Mailing Address
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Address Line | 611 N POINSETTIA PL
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City | LOS ANGELES
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State | CA
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Zip | 90036-1926
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Country | US
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Telephone | 323-395-4581
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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 | 31048
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License Number State | CA
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