Manju Marin Chacko, CCC - SLP
Individual provider Active NPI Speech-Language Pathologist · American Canyon, CA
NPI 1881969673 · NPPES record last updated May 6, 2026
Key facts
- NPI
- 1881969673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 17280 (CA)
- Practice address
- 227 Reliant Way
American Canyon, CA 94503-3236 - Phone
- (626) 321-7296
- NPI assigned
- Mar 13, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
5820 Owens Dr
Pleasanton, CA 94588-3900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260619001242 | CA | Practitioner - Qualified Speech Language Pathologist | 4486126570 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17280 | CA | MD | Psychologist |
| 103308 | TX | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 17280 | CA | Yes |
| Speech-Language Pathologist | 235Z00000X | 103308 | TX |
Addresses
Primary practice location
227 Reliant Way
American Canyon, CA 94503-3236
Mailing address
227 Reliant Way
American Canyon, CA 94503-3236
Phone (626) 321-7296
Other providers in American Canyon, CA
- Kevin James Cabugao
- California Dental Care, Nahreen Imam, DDS, Inc.
- Canyon Ranch Dental Care Inc.
- Stephanie Doreen Carpersmith
- Joseph Carter
- Adrian Chavez
- Kristine Cheuk
- Darlene Barga Chiu
- Betty Christensen
- Christin Brennan Cirillo
All providers in American Canyon, CA · Speech-Language Pathologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.