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Organization
COMMUNITY SPEECH CENTER OF UPLAND
Active
Organization
COMMUNITY SPEECH CENTER OF UPLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELIZABETH MADKIN MA CCC SLP (SPEECH PATHOLOGIST)
(909) 908-1771
Entity
Organization
Contact information
Practice address
900 E HARRISON AVE APT C23, POMONA, CA 91767-2043
(909) 541-7654
(909) 626-7977
Mailing address
900 E HARRISON AVE APT C23, POMONA, CA 91767-2043
(909) 908-1771
(909) 981-2039
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP 1902
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ57586Y
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
02/16/2007
Last updated
12/28/2023
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