Provider Demographics
NPI:1689222846
Name:FREEDLAND, MARCIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:FREEDLAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-3251
Mailing Address - Country:US
Mailing Address - Phone:312-560-3920
Mailing Address - Fax:
Practice Address - Street 1:913 18TH ST APT 5
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3251
Practice Address - Country:US
Practice Address - Phone:312-560-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004257235Z00000X
CA21596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist