Healthcare Provider Details

I. General information

NPI: 1427965102
Provider Name (Legal Business Name): IVY GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 CLARK RD
PARADISE CA
95969-2861
US

IV. Provider business mailing address

2321 EUGENE AVE
CHICO CA
95926-1903
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-6400
  • Fax:
Mailing address:
  • Phone: 530-845-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: