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General NPI Number Information
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NPI Number | 1952731598
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Entity Type | Organization
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Legal Business Name | BALIAN SPEECH AND LANGUAGE THERAPY AND DIAGNOSTICS
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 05/25/2014
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Provider Practice Location Address
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Address Line | 1011 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2646
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Country | US
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Telephone | 818-434-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2646
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Country | US
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Telephone | 818-434-5120
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | LUSINE BALIAN
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Credential | M.S. CCC-SLP
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Telephone | 818-434-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SP 20809
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License Number State | CA
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