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General NPI Number Information
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NPI Number | 1992358543
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Entity Type | Organization
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Legal Business Name | CROSSROADS SPEECH & LANGUAGE PATHOLOGY SERVICES, INC.
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 12010 TEXAS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-1311
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Country | US
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Telephone | 310-383-9528
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Fax |
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Provider Business Mailing Address
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Address Line | 12010 TEXAS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-1311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. SIMA KHADEM
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Credential | CCC-SLP
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Telephone | 310-962-3883
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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 |
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License Number State |
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