Individual
STACEY ANN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 COFFEE RD, MODESTO, CA 95355-4204
(209) 492-2470
Mailing address
1000 COFFEE RD, MODESTO, CA 95355-4204
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
11/26/2025
Last updated
01/23/2026
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