MEDICARE: SIMPLY SPEECH LANGUAGE PATHOLOGY CORPORATION

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1730817396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY SPEECH LANGUAGE PATHOLOGY CORPORATION

Provider Business Mailing Address
First Line	:	214 N CATALINA AVE APT 7
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2858
Country	:	US
Telephone Number	:	310-753-4801
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 N CATALINA AVE APT 7
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2858
Country	:	US
Telephone Number	:	310-753-4801
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ERYN HARMAN
Credential	:
Telephone Number	:	310-753-4801

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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