Organization
BLOSSOM SPEECH AND LANGUAGE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYLYN LUCAS M.A., CCC-SLP (OWNER)
(209) 404-0333
Entity
Organization
Contact information
Practice address
1101 STANDIFORD AVE STE A2, MODESTO, CA 95350-0981
(209) 404-0333
Mailing address
5819 CHENAULT DR, MODESTO, CA 95356-9621
(209) 404-0333
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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