MEDICARE: DR. KIRSTEN ACKER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	26425	CA
2	103T00000X	Psychologist	PSY26425	CA

General Provider Information

NPI Number	:	1235346156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN ACKER PSYD

Provider Business Mailing Address
First Line	:	3301 E 12TH ST
Second Line	:	SUITE 259
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:	510-269-9031

Provider Business Practice Location Address
First Line	:	3301 E 12TH ST
Second Line	:	SUITE 259
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:	510-269-9031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	02/26/2018

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