MEDICARE: SALLY JO LILJEDAHL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS20460	CA
2	1041S0200X	School Social Worker		CA

General Provider Information

NPI Number	:	1326105917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY JO LILJEDAHL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 221261
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91322-1261
Country	:	US
Telephone Number	:	661-857-0234
Fax Number	:	661-513-9520

Provider Business Practice Location Address
First Line	:	28494 WESTINGHOUSE PL
Second Line	:	SUITE 313
City	:	VALENCIA
State	:	CA
Zip	:	91355-0930
Country	:	US
Telephone Number	:	661-857-0234
Fax Number	:	661-513-9520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/11/2025

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