Healthcare Provider Details

I. General information

NPI: 1649037979
Provider Name (Legal Business Name): CLINICAL SUPERVISION SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST # 10048
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST # 10048
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 757-272-8765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASSIDY KOBIALKA
Title or Position: SPEECH LANGUAGE PATHOLOGIST/ OWNER
Credential: M.S., CCC-SLP
Phone: 757-272-8765