Healthcare Provider Details

I. General information

NPI: 1285557843
Provider Name (Legal Business Name): ELIZABETH LADINE PPS SCHOOL PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

601 COLORADO AVE
TURLOCK CA
95380-4169
US

IV. Provider business mailing address

2205 TOKAY AVE
TURLOCK CA
95380-4350
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-8519
  • Fax:
Mailing address:
  • Phone: 209-667-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220077791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: