Organization
LAWRENCE CHESPAK, APC
Active
Other names
VITAL SPEECH AND SWALLOW, APC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE WALTER CHESPAK M.D. (PRESIDENT)
(818) 707-7704
Entity
Organization
Contact information
Practice address
5554 RESEDA BLVD, SUITE 103, TARZANA, CA 91356-2200
(818) 707-7704
(818) 708-7707
Mailing address
5554 RESEDA BLVD, SUITE 103, TARZANA, CA 91356-2200
(818) 707-7704
(818) 708-7707
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G62697
CA
235Z00000X
Speech-Language Pathologist
CCC9644
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
704362
ACN PROVIDER
CA
01
—
CCC9644
SLP LICENSE
CA
01
—
G62697
LICENSE NUMBER
CA
01
—
ZZZ67240Z
BLUE SHIELD PROVIDER
CA
Enumeration date
05/16/2007
Last updated
03/10/2008
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