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General NPI Number Information
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NPI Number | 1407630759
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Entity Type | Organization
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Legal Business Name | SOCIAL COMPASS CLUB, A SPEECH-LANGUAGE PATHOLOGY CORPORATION
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 2233 HONOLULU AVE UNIT 312
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City | MONTROSE
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State | CA
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Zip | 91020-1635
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Country | US
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Telephone | 818-839-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 HONOLULU AVE UNIT 312
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City | MONTROSE
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State | CA
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Zip | 91020-1635
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Country | US
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Telephone | 818-839-0855
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/PRESIDENT
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Name | MS. LISA JORGENSEN-BOCK
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Credential | M.S., CCC-SLP
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Telephone | 818-839-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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