Provider Demographics
NPI:1649350570
Name:LARRY KLEIMAN & ASSOCIATES SPEECH PATHOLOGY CORP
Entity type:Organization
Organization Name:LARRY KLEIMAN & ASSOCIATES SPEECH PATHOLOGY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:KLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC
Authorized Official - Phone:562-598-9555
Mailing Address - Street 1:4132 KATELLA AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ALAMTIOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6601
Mailing Address - Country:US
Mailing Address - Phone:562-598-9555
Mailing Address - Fax:562-598-9898
Practice Address - Street 1:4132 KATELLA AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ALAMTIOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6601
Practice Address - Country:US
Practice Address - Phone:562-598-9555
Practice Address - Fax:562-598-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP4176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0041760Medicaid