MEDICARE: MS. VIVIAN MARI GLUCKSMAN-WEISS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP3097	CA

General Provider Information

NPI Number	:	1306828835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIVIAN MARI GLUCKSMAN-WEISS MA

Provider Business Mailing Address
First Line	:	13347 KILLION STREET
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5337
Country	:	US
Telephone Number	:	818-902-3848
Fax Number	:

Provider Business Practice Location Address
First Line	:	13347 KILLION STREET
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5337
Country	:	US
Telephone Number	:	818-902-3848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. VIVIAN MARI GLUCKSMAN-WEISS MA” Practice Location

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