Healthcare Provider Details

I. General information

NPI: 1730083981
Provider Name (Legal Business Name): ALEXANDRIA FAITH VAN DER MAATEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 CARMEL RANCH CIR
OAKDALE CA
95361-7664
US

IV. Provider business mailing address

2010 CARMEL RANCH CIR
OAKDALE CA
95361-7664
US

V. Phone/Fax

Practice location:
  • Phone: 209-253-6764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: