Provider Demographics
NPI:1487082285
Name:MAZDA SPEECH LANGUAGE DEVELOPMENT CENTER
Entity type:Organization
Organization Name:MAZDA SPEECH LANGUAGE DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PERVEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATRACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:661-253-0245
Mailing Address - Street 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE # 103B
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:661-253-0245
Mailing Address - Fax:661-253-0310
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE # 103B
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:661-253-0245
Practice Address - Fax:661-253-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17812261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech