INNOVATIVE SPEECH & LANGUAGE PATHOLOGY INC

Provider Demographics

• NPI: 1619340098
• Name: INNOVATIVE SPEECH & LANGUAGE PATHOLOGY INC
• Entity Type: Organization
• Organization Name: INNOVATIVE SPEECH & LANGUAGE PATHOLOGY INC
• Other - Org Name: OMIX THERAPIES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: SEO
• Authorized Official - First Name: ODELIA
• Authorized Official - Last Name: MIRZADEH
• Authorized Official - Credentials: SLP
• Authorized Official - Phone: 310-659-9511
• Mailing Address - Street 1: 8501 WILSHIRE BLVD STE 336
• Mailing Address - City: BEVERLY HILLS
• Mailing Address - State: CA
• Mailing Address - Zip Code: 90211-3134
• Mailing Address - Country: US
• Mailing Address - Phone: 310-659-9511
• Mailing Address - Fax: 818-697-9319
• Practice Address - Street 1: 8501 WILSHIRE BLVD STE 336
• Practice Address - City: BEVERLY HILLS
• Practice Address - State: CA
• Practice Address - Zip Code: 90211-3134
• Practice Address - Country: US
• Practice Address - Phone: 310-659-9511
• Practice Address - Fax: 818-697-9319
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2015-11-05
• Last Update Date: 2021-03-30

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	103K00000X	Behavioral Health & Social Service Providers	Behavior Analyst		Group - Multi-Specialty
No	106E00000X	Behavioral Health & Social Service Providers	Assistant Behavior Analyst		Group - Multi-Specialty
No	106S00000X	Behavioral Health & Social Service Providers	Behavior Technician		Group - Multi-Specialty
No	175L00000X	Other Service Providers	Homeopath		Group - Multi-Specialty
No	2080P0006X	Allopathic & Osteopathic Physicians	Pediatrics	Developmental - Behavioral Pediatrics	Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	225XF0002X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist	Feeding, Eating & Swallowing	Group - Multi-Specialty
No	225XP0200X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist	Pediatrics	Group - Multi-Specialty
No	252Y00000X	Agencies	Early Intervention Provider Agency
No	261QD1600X	Ambulatory Health Care Facilities	Clinic/Center	Developmental Disabilities
No	261QH0700X	Ambulatory Health Care Facilities	Clinic/Center	Hearing and Speech	Group - Multi-Specialty
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)	Group - Multi-Specialty
No	261QM3000X	Ambulatory Health Care Facilities	Clinic/Center	Medically Fragile Infants and Children Day Care	Group - Multi-Specialty
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy	Group - Multi-Specialty