Provider Demographics
NPI:1497077879
Name:PATHWAYS SPEECH AND LANGUAGE
Entity Type:Organization
Organization Name:PATHWAYS SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SPEECH LANGUAGE PATHOLOGIS
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:310-581-6430
Mailing Address - Street 1:3205 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3224
Mailing Address - Country:US
Mailing Address - Phone:310-581-6430
Mailing Address - Fax:310-581-6433
Practice Address - Street 1:3205 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3224
Practice Address - Country:US
Practice Address - Phone:310-581-6430
Practice Address - Fax:310-581-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty