Larisa Chudnovskaya, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

26048 Issued in CA

Practice address

10800 Farragut Dr
Culver City, CA 90230-4107

Phone

(424) 341-0151

NPI assigned

Jan 9, 2017

Reactivated

Mar 23, 2021

Last updated

Mar 25, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1073059572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19750 S VERMONT AVE",
            "address_2": "SUITE 140",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905021119",
            "telephone_number": "424-233-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 FARRAGUT DR",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304107",
            "telephone_number": "424-341-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUDNOVSKAYA",
        "first_name": "LARISA",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-09",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "deactivation_date": "2021-03-03",
        "reactivation_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "RPE 11102",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "26048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Culver City, CA
• Providers in Culver City, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.