Provider Demographics
NPI:1447589320
Name:HADDAD, LARA B (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:B
Last Name:HADDAD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7121
Mailing Address - Country:US
Mailing Address - Phone:818-344-0679
Mailing Address - Fax:
Practice Address - Street 1:26560 AGOURA RD
Practice Address - Street 2:#110-B
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1926
Practice Address - Country:US
Practice Address - Phone:818-880-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist