=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720891633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA PEDIATRIC FEEDING AND SPEECH THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 02/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4933 PETIT AVE
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-866-8127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16350 VENTURA BLVD STE D173
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-5300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-866-8127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, SLP
-----------------------------------------------------
Name | DR. ANNA GROSS
-----------------------------------------------------
Credential | SLPD, CCC-SLP, CLC
-----------------------------------------------------
Telephone | 310-866-8127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------