MEDICARE: MERRY GOLBAD SPEECH PATHOLOGIST

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	17710	CA

General Provider Information

NPI Number	:	1528623642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRY GOLBAD SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	5351 AMIGO AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4111
Country	:	US
Telephone Number	:	818-621-7879
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 TOPANGA CANYON BLVD STE 201
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1770
Country	:	US
Telephone Number	:	818-621-7879
Fax Number	:

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

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	08/08/2019

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