Provider Demographics
NPI:1407063837
Name:LAWRENCE CHESPAK, APC
Entity Type:Organization
Organization Name:LAWRENCE CHESPAK, APC
Other - Org Name:VITAL SPEECH AND SWALLOW, APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CHESPAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-707-7704
Mailing Address - Street 1:5554 RESEDA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2200
Mailing Address - Country:US
Mailing Address - Phone:818-707-7704
Mailing Address - Fax:818-708-7707
Practice Address - Street 1:5554 RESEDA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2200
Practice Address - Country:US
Practice Address - Phone:818-707-7704
Practice Address - Fax:818-708-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62697174400000X
CACCC9644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ67240ZOtherBLUE SHIELD PROVIDER
CACCC9644OtherSLP LICENSE
CA704362OtherACN PROVIDER
CAG62697OtherLICENSE NUMBER
CA704362OtherACN PROVIDER
CAW19128Medicare ID - Type UnspecifiedPROVIDER NUMBER