Provider Demographics
NPI:1356945307
Name:LISA KLEIN SPEECH PATHOLOGY CORPORTATION
Entity type:Organization
Organization Name:LISA KLEIN SPEECH PATHOLOGY CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP COM
Authorized Official - Phone:310-739-9337
Mailing Address - Street 1:12121 WILSHIRE BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1176
Mailing Address - Country:US
Mailing Address - Phone:310-739-9337
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD STE 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1176
Practice Address - Country:US
Practice Address - Phone:310-739-9337
Practice Address - Fax:310-844-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty