Provider Demographics
NPI:1619264132
Name:NEURODEVELOPMENTAL LEARNING INSTITUTE
Entity Type:Organization
Organization Name:NEURODEVELOPMENTAL LEARNING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAYEM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:310-305-1654
Mailing Address - Street 1:8055 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7960
Mailing Address - Country:US
Mailing Address - Phone:310-305-1654
Mailing Address - Fax:
Practice Address - Street 1:8055 W MANCHESTER AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7960
Practice Address - Country:US
Practice Address - Phone:310-305-1654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18502106H00000X
CA11010225X00000X
CA10919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty