Provider Demographics
NPI:1942877113
Name:SOUTHERN CALIFORNIA SPEECH LANGUAGE CENTER
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA SPEECH LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:909-802-0916
Mailing Address - Street 1:1215 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1053
Mailing Address - Country:US
Mailing Address - Phone:909-802-0916
Mailing Address - Fax:
Practice Address - Street 1:8062 CALLE CARABE CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1903
Practice Address - Country:US
Practice Address - Phone:909-802-0916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty