Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ivy Glaze Vidad

Individual provider Behavior Technician · NPI 1700393428

Ivy Glaze Vidad is a Behavior Technician in Stockton, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2018

Practice location Address checks out

2453 Grand Canal Blvd Ste A
Stockton, CA 95207-8259
Phone: (855) 223-7123
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence 1212345 (CA)

Record details

NPI number1700393428
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 3, 2018
Last updated in NPPESAugust 19, 2021
Certification dateAugust 19, 2021

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