Healthcare Provider Details

I. General information

NPI: 1548804222
Provider Name (Legal Business Name): ILENE GOVEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SHAW AVE STE 101
CLOVIS CA
93612-3819
US

IV. Provider business mailing address

1219 E DINUBA AVE # 11
REEDLEY CA
93654-3557
US

V. Phone/Fax

Practice location:
  • Phone: 559-545-1170
  • Fax:
Mailing address:
  • Phone: 559-321-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: