MEDICARE: JUST KIDS LEARNING CENTER

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	252Y00000X	Early Intervention Provider Agency	SP12079	CA
2	235Z00000X	Speech-Language Pathologist	SP12079	CA

General Provider Information

NPI Number	:	1407038110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST KIDS LEARNING CENTER

Provider Business Mailing Address
First Line	:	2722 GOUGH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4405
Country	:	US
Telephone Number	:	415-775-5511
Fax Number	:	415-775-5521

Provider Business Practice Location Address
First Line	:	2722 GOUGH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4405
Country	:	US
Telephone Number	:	415-775-5511
Fax Number	:	415-775-5521

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JENNIFER A LOPEZ
Credential	:	MS, CCC-SLP
Telephone Number	:	415-775-5511

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	04/01/2009

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Directions to “JUST KIDS LEARNING CENTER ” Practice Location

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