Active NPI
Grace Philippa Vitale, MA
- Speech-Language Pathologist
- Northridge, CA
National Provider Identifier
1396853552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP0067960
- Practice address
- 8345 Reseda BL
#106
Northridge, CA 91324 - Phone
- (818) 345-2684
- Fax
- (818) 345-2684
- NPI assigned
- Aug 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP0067960 | CA | Primary |
Addresses
Primary practice location
8345 Reseda BL
#106
Northridge, CA 91324
Mailing address
17077 7 Roscoe BL
Northridge, CA 91325
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SP0067960 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP0067960 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396853552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17077 7 ROSCOE BL",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "91325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8345 RESEDA BL",
"address_2": "#106",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "91324",
"telephone_number": "818-345-2684",
"fax_number": "818-345-2684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITALE",
"first_name": "GRACE",
"middle_name": "PHILIPPA",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP0067960",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SP0067960",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.