Shannon Broussalian, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP17445 Issued in CA

Practice address

11150 Bertrand Ave
Granada Hills, CA 91344-4005

Phone

(818) 915-1966

NPI assigned

Apr 28, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Generation Speech Therapy, Inc.

  • Speech-Language Pathologist
  • Granada Hills, CA
  • NPI 1184112757
  NPD (past) Authorized official

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

{
    "created_epoch": "1524873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524873600000",
    "number": "1538657101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11150 BERTRAND AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913444005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 BERTRAND AVE",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913444005",
            "telephone_number": "818-915-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSALIAN",
        "first_name": "SHANNON",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-28",
        "last_updated": "2018-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP17445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Broadwater Rinaldi Care Center, LLC (Rinaldi Convalescent Hospital)
• Brock Lorenz DMD Ms Inc
• Brooks Womens Center
• Marlon Brooks, MD
• Brougham Ambulance
• Janet Broutian, PHARMD
• Joanne Broutt
• Carolyn Anne Browne, D.D.S.
• Mirna Bshara
• Rizza Buan-Mendiola

• Speech-Language Pathologist in Granada Hills, CA
• Providers in Granada Hills, 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 Apr 28, 2018; 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.