Provider Demographics
NPI:1326105917
Name:LILJEDAHL, SALLY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JO
Last Name:LILJEDAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221261
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91322-1261
Mailing Address - Country:US
Mailing Address - Phone:661-857-0234
Mailing Address - Fax:661-513-9520
Practice Address - Street 1:28494 WESTINGHOUSE PL
Practice Address - Street 2:SUITE 313
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0930
Practice Address - Country:US
Practice Address - Phone:661-857-0234
Practice Address - Fax:661-513-9520
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS204601041C0700X
CA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool