MEDICARE: MIND BODY VOICE AND SPEECH

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	:	1679112940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND BODY VOICE AND SPEECH

Provider Business Mailing Address
First Line	:	205 N SERRANO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N SERRANO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4207
Country	:	US
Telephone Number	:	323-283-9750
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	LIANA GUO
Credential	:
Telephone Number	:	323-283-9570

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	02/05/2022

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Directions to “MIND BODY VOICE AND SPEECH ” Practice Location

Language	Start Address	Practice Location

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