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Individual

GRACE PHILIPPA VITALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
8345 RESEDA BL, #106, NORTHRIDGE, CA 91324
(818) 345-2684
(818) 345-2684
Mailing address
17077 7 ROSCOE BL, NORTHRIDGE, CA 91325

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP0067960
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SP0067960
CA
Enumeration date
08/28/2006
Last updated
07/08/2007
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