Healthcare Provider Details

I. General information

NPI: 1730512328
Provider Name (Legal Business Name): BLANCA GABRIELA SALCEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 S. AUSTIN ROAD
STOCKTON CA
95215-8312
US

IV. Provider business mailing address

7707 AUSTIN RD
STOCKTON CA
95215-8312
US

V. Phone/Fax

Practice location:
  • Phone: 209-518-1705
  • Fax:
Mailing address:
  • Phone: 209-467-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36730
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW76042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: