Healthcare Provider Details

I. General information

NPI: 1730067158
Provider Name (Legal Business Name): ROSE LETKEMANN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S HALCYON RD STE 101
ARROYO GRANDE CA
93420-3174
US

IV. Provider business mailing address

2552 EILEEN AVE
SANGER CA
93657-3846
US

V. Phone/Fax

Practice location:
  • Phone: 805-801-2231
  • Fax:
Mailing address:
  • Phone: 559-931-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number156298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: