Healthcare Provider Details

I. General information

NPI: 1932612876
Provider Name (Legal Business Name): RAMONA LYNN CANADY CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DOWNEY AVE
MODESTO CA
95354-1208
US

IV. Provider business mailing address

121 DOWNEY AVE
MODESTO CA
95354-1208
US

V. Phone/Fax

Practice location:
  • Phone: 209-604-3495
  • Fax:
Mailing address:
  • Phone: 209-604-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC031370315
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberC031370315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: