Provider Demographics
NPI:1467222752
Name:WILLOW TREE THERAPY
Entity Type:Organization
Organization Name:WILLOW TREE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SASUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:818-370-5886
Mailing Address - Street 1:405 PIONEER DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3825
Mailing Address - Country:US
Mailing Address - Phone:818-370-5886
Mailing Address - Fax:
Practice Address - Street 1:405 PIONEER DR UNIT 10
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3825
Practice Address - Country:US
Practice Address - Phone:818-370-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech