Provider Demographics
NPI:1265663900
Name:SMILE PEDIATRIC SPEECH THERAPY & DIAGNOSTICS INC.
Entity Type:Organization
Organization Name:SMILE PEDIATRIC SPEECH THERAPY & DIAGNOSTICS INC.
Other - Org Name:SMILE PEDIATRIC THERAPY & DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:323-747-5055
Mailing Address - Street 1:1639 WATERLOO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2422
Mailing Address - Country:US
Mailing Address - Phone:323-747-5055
Mailing Address - Fax:213-483-8537
Practice Address - Street 1:3031 BEVERLY BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1013
Practice Address - Country:US
Practice Address - Phone:323-747-5055
Practice Address - Fax:213-483-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA14510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty