MEDICARE: EMILY COURSEN M.S., CCC-SLP

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

General Provider Information

NPI Number	:	1376115402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY COURSEN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2563 S SEPULVEDA BLVD APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3174
Country	:	US
Telephone Number	:	609-694-1255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2563 S SEPULVEDA BLVD APT 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3174
Country	:	US
Telephone Number	:	609-694-1255
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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Directions to “ EMILY COURSEN M.S., CCC-SLP” Practice Location

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