NPIMap

Organization Active NPI

Los Angeles Speech and Language Therapy Center Inc

  • Speech-Language Pathologist
  • Culver City, CA
National Provider Identifier
1386975233
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP3380 Issued in CA
Legal business name
LOS ANGELES SPEECH AND LANGUAGE THERAPY CENTER INC
Practice address
5761 Buckingham Pkwy
Culver City, CA 90230-6515
Phone
(310) 649-6199
Fax
(310) 649-5597
NPI assigned
Jan 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Authorized official

Name
Dr. Pamela Sue Wiley, PH.D., CCC-SLP
Title
Owner-President/SLP
Phone
(310) 649-6199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X SP3380 CA Primary

Addresses

Primary practice location

5761 Buckingham Pkwy
Culver City, CA 90230-6515

Mailing address

5761 Buckingham Pkwy
Culver City, CA 90230-6515
Phone (310) 649-6199

Other identifiers 1

IdentifierTypeStateIssuer
GSP000290OtherCAMEDI-CAL

National Provider Directory

National Provider Directory

Locations

5761 Buckingham Pkwy
Culver City, CA 90230
Phone (310) 649-6199

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1386975233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5761 BUCKINGHAM PKWY",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306515",
            "telephone_number": "310-649-6199",
            "fax_number": "310-649-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5761 BUCKINGHAM PKWY",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306515",
            "telephone_number": "310-649-6199",
            "fax_number": "310-649-5597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES SPEECH AND LANGUAGE THERAPY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER-PRESIDENT/SLP",
        "authorized_official_telephone_number": "310-649-6199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP3380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "GSP000290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.