Provider Demographics
NPI:1427417666
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:310-569-4622
Mailing Address - Street 1:1041 ELKGROVE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3191
Mailing Address - Country:US
Mailing Address - Phone:310-569-4622
Mailing Address - Fax:
Practice Address - Street 1:1041 ELKGROVE AVE
Practice Address - Street 2:APARTMENT #4
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3191
Practice Address - Country:US
Practice Address - Phone:310-569-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23411282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital