MEDICARE: KAITLYN GREANEY

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1497237960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN GREANEY

Provider Business Mailing Address
First Line	:	13066 VAN NUYS BLVD
Second Line	:
City	:	PACOIMA
State	:	CA
Zip	:	91331-2576
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 E LOS ANGELES AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5213
Country	:	US
Telephone Number	:	805-214-1488
Fax Number	:

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

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	08/31/2018

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Directions to “ KAITLYN GREANEY ” Practice Location

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