Healthcare Provider Details

I. General information

NPI: 1194634121
Provider Name (Legal Business Name): LIDDICOAT LANGUAGE & LITERACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 RIVER MEADOWS DR
WOODBRIDGE CA
95258-9312
US

IV. Provider business mailing address

PO BOX 312
WOODBRIDGE CA
95258-0312
US

V. Phone/Fax

Practice location:
  • Phone: 209-712-7275
  • Fax:
Mailing address:
  • Phone: 209-712-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LORI LIDDICOAT
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: MS, CCC, SLP
Phone: 209-712-7275