Healthcare Provider Details

I. General information

NPI: 1003721556
Provider Name (Legal Business Name): FELICIA ROSE GARCIA ANSELMO M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 LEVER BLVD
STOCKTON CA
95206-2855
US

IV. Provider business mailing address

1903 GLISSANDO VISTA ST
HENDERSON NV
89044-2027
US

V. Phone/Fax

Practice location:
  • Phone: 209-933-7405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: