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NPI Code Detail

MEDICARE: MLS SPEECH PATHOLOGY INC.

MEDICARE: MLS SPEECH PATHOLOGY INC.
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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1912670803
Entity Type Code : Organization
Provider Name (Legal Business Name) : MLS SPEECH PATHOLOGY INC.
Provider Business Mailing Address
First Line : 7042 AZURE BEACH ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2856
Country : US
Telephone Number : 408-905-6127
Fax Number :
Provider Business Practice Location Address
First Line : 330 N BRAND BLVD STE 700
Second Line :
City : GLENDALE
State : CA
Zip : 91203-2336
Country : US
Telephone Number : 408-905-6127
Fax Number :
Authorized Official
Title or Position : OWNER/CEO
Name : MRS. MADONNA LAZO-SMITH
Credential : MA CCC-SLP
Telephone Number : 408-905-6127
Provider Enumeration Date : 07/27/2021
Last Update Date : 07/27/2021

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Directions to “MLS SPEECH PATHOLOGY INC. ” Practice Location

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