Healthcare Provider Details

I. General information

NPI: 1053234252
Provider Name (Legal Business Name): MADELEINE ROSE PACH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WILLOW PASS RD STE 700
CONCORD CA
94520-7926
US

IV. Provider business mailing address

516 NE STAFFORD ST
PORTLAND OR
97211-2850
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-1474
  • Fax:
Mailing address:
  • Phone: 916-595-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18522
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: