Healthcare Provider Details

I. General information

NPI: 1235261223
Provider Name (Legal Business Name): CONSTANCE DIANE LOHSE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 ENTERPRISE DR
AUBURN CA
95603-3732
US

IV. Provider business mailing address

522 OAK ST
ROSEVILLE CA
95678-2621
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-6700
  • Fax: 530-889-6735
Mailing address:
  • Phone: 916-787-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: