Provider Demographics
NPI:1982487062
Name:KHATCHETOURIAN, EMILIE CELINE (MS)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:CELINE
Last Name:KHATCHETOURIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:EMILIE
Other - Middle Name:CELINE
Other - Last Name:KARIMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2849 MARY ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3419
Mailing Address - Country:US
Mailing Address - Phone:818-429-2698
Mailing Address - Fax:
Practice Address - Street 1:425 W BROADWAY STE 450
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1366
Practice Address - Country:US
Practice Address - Phone:818-649-1053
Practice Address - Fax:818-245-9338
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist