Healthcare Provider Details

I. General information

NPI: 1932046661
Provider Name (Legal Business Name): MOLLIE JASSAL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 LEHNER AVE
ESCONDIDO CA
92026-1512
US

IV. Provider business mailing address

2336 HOSP WAY UNIT 316
CARLSBAD CA
92008-1224
US

V. Phone/Fax

Practice location:
  • Phone: 978-319-5038
  • Fax:
Mailing address:
  • Phone: 978-319-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number78442
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: