Provider Demographics
NPI:1669790887
Name:JACKIE KREITZMAN AND ASSOCIATES
Entity type:Organization
Organization Name:JACKIE KREITZMAN AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:818-705-6988
Mailing Address - Street 1:5567 RESEDA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2674
Mailing Address - Country:US
Mailing Address - Phone:818-705-6988
Mailing Address - Fax:818-996-9339
Practice Address - Street 1:5567 RESEDA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2674
Practice Address - Country:US
Practice Address - Phone:818-705-6988
Practice Address - Fax:818-996-9339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25692106H00000X
CASP 4063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty