Provider Demographics
NPI:1700184405
Name:MADAMBA, MARGIE (SP)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:MADAMBA
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CECELIA
Other - Last Name:KOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:PO BOX 13005
Mailing Address - Street 2:7009 QUAILWOOD DRIVE, BAKERSFIELD, CA 93389
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-3005
Mailing Address - Country:US
Mailing Address - Phone:661-836-1623
Mailing Address - Fax:661-836-8486
Practice Address - Street 1:7009 QUAILWOOD DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1345
Practice Address - Country:US
Practice Address - Phone:661-836-1623
Practice Address - Fax:661-836-8486
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP14231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700184405OtherPRIVATE INSURANCE