Provider Demographics
NPI:1013245687
Name:VITAL SPEECH AND SWALLOW
Entity Type:Organization
Organization Name:VITAL SPEECH AND SWALLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHITNITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:818-708-7704
Mailing Address - Street 1:5554 RESEDA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6221
Mailing Address - Country:US
Mailing Address - Phone:818-708-7704
Mailing Address - Fax:818-708-7707
Practice Address - Street 1:5554 RESEDA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6221
Practice Address - Country:US
Practice Address - Phone:818-708-7704
Practice Address - Fax:818-708-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCC9644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty