Healthcare Provider Details

I. General information

NPI: 1497576235
Provider Name (Legal Business Name): KASSANDRA MEJIA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11434 B AVE
AUBURN CA
95603-2603
US

IV. Provider business mailing address

908 3RD ST
WHEATLAND CA
95692-9788
US

V. Phone/Fax

Practice location:
  • Phone: 530-906-5526
  • Fax:
Mailing address:
  • Phone: 916-792-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW109754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: