Provider Demographics
NPI:1073873451
Name:SOCIAL COMMUNICATION SPECIALISTS SPEECH THERAPY CLINIC APC
Entity Type:Organization
Organization Name:SOCIAL COMMUNICATION SPECIALISTS SPEECH THERAPY CLINIC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:858-558-9552
Mailing Address - Street 1:5665 OBERLIN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1737
Mailing Address - Country:US
Mailing Address - Phone:858-558-9552
Mailing Address - Fax:
Practice Address - Street 1:5665 OBERLIN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1737
Practice Address - Country:US
Practice Address - Phone:858-558-9552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty