Provider Demographics
NPI:1609316785
Name:SASSOON, SHIRI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRI
Middle Name:
Last Name:SASSOON
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 1:1926 GLENDON AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8415
Mailing Address - Country:US
Mailing Address - Phone:310-488-9669
Mailing Address - Fax:
Practice Address - Street 1:1926 GLENDON AVE
Practice Address - Street 2:UNIT 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8415
Practice Address - Country:US
Practice Address - Phone:310-488-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist