Provider Demographics
NPI:1790549830
Name:BTMG SPEECH CLINIC, PC
Entity Type:Organization
Organization Name:BTMG SPEECH CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYESH ZITOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC - SLP
Authorized Official - Phone:818-941-3388
Mailing Address - Street 1:16255 VENTURA BLVD STE 1015
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2318
Mailing Address - Country:US
Mailing Address - Phone:818-941-3388
Mailing Address - Fax:
Practice Address - Street 1:16255 VENTURA BLVD STE 1015
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2318
Practice Address - Country:US
Practice Address - Phone:818-941-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6547542Medicaid