Provider Demographics
NPI:1558747998
Name:BEKMAN, MIKAELA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:BEKMAN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 COLDWATER CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1676
Mailing Address - Country:US
Mailing Address - Phone:818-802-0730
Mailing Address - Fax:
Practice Address - Street 1:5135 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1676
Practice Address - Country:US
Practice Address - Phone:818-802-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2774235Z00000X
CA27024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27024OtherSPEECH AND LANGUAGE BOARD
NVSP-2774OtherNV SPEECH AND LANGUAGE BOARD
CA100346669001OtherBLUE SHIELD PPO PROVIDER