Healthcare Provider Details

I. General information

NPI: 1588518740
Provider Name (Legal Business Name): MADELINE SHANABRUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 E LASSEN AVE
CHICO CA
95973-7824
US

IV. Provider business mailing address

1359 E LASSEN AVE
CHICO CA
95973-7824
US

V. Phone/Fax

Practice location:
  • Phone: 530-230-9230
  • Fax: 530-466-3154
Mailing address:
  • Phone: 530-230-9230
  • Fax: 530-466-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: