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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