Healthcare Provider Details

I. General information

NPI: 1427965433
Provider Name (Legal Business Name): MADISON BLANC M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W MARCH LN STE 117S
STOCKTON CA
95219-6500
US

IV. Provider business mailing address

545 SAGEWALK CT
OAKDALE CA
95361-8928
US

V. Phone/Fax

Practice location:
  • Phone: 209-952-2588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberRPE22126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: