Provider Demographics
NPI:1699084897
Name:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DORINDA
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MS, CCC-SLP
Authorized Official - Phone:818-677-6002
Mailing Address - Street 1:18111 NORDHOFF STREET
Mailing Address - Street 2:MONTEREY HALL, ROOM 100
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91330-8288
Mailing Address - Country:US
Mailing Address - Phone:818-677-2856
Mailing Address - Fax:818-677-5952
Practice Address - Street 1:18111 NORDHOFF STREET
Practice Address - Street 2:MONTEREY HALL, ROOM 100
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91330-8288
Practice Address - Country:US
Practice Address - Phone:818-677-2856
Practice Address - Fax:818-677-5952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA STATE UNIVERSITY NORTHRIDGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency