MEDICARE: JODIE VICTOR M.S., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP008450	GA
2	235Z00000X	Speech-Language Pathologist	27664	CA

General Provider Information

NPI Number	:	1417365248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE VICTOR M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	21515 HAWTHORNE BLVD STE GL-100
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21515 HAWTHORNE BLVD STE GL-100
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6501
Country	:	US
Telephone Number	:	424-571-2618
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	01/23/2025

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Directions to “ JODIE VICTOR M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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