Provider Demographics
NPI:1407630759
Name:LISA M JORGENSEN SOCIAL COMPASS CLUB
Entity Type:Organization
Organization Name:LISA M JORGENSEN SOCIAL COMPASS CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JORGENSEN-BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:818-839-0855
Mailing Address - Street 1:2233 HONOLULU AVE UNIT 312
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1635
Mailing Address - Country:US
Mailing Address - Phone:818-839-0855
Mailing Address - Fax:
Practice Address - Street 1:2233 HONOLULU AVE UNIT 312
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1635
Practice Address - Country:US
Practice Address - Phone:818-839-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty