=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619264132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURODEVELOPMENTAL LEARNING INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2011
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12063 JEFFERSON BLVD # A
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-6219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-821-3640
-----------------------------------------------------
Fax | 310-526-3438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12063 JEFFERSON BLVD # A
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-6219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-821-3640
-----------------------------------------------------
Fax | 310-526-3438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ERIN D KAYEM
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 310-384-5159
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 18502
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 11010
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 10919
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------