Healthcare Provider Details

I. General information

NPI: 1194028381
Provider Name (Legal Business Name): SYDNEE KAE STEPHENS SUDCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 10/21/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE.
CERES CA
95307
US

IV. Provider business mailing address

1904 RICHLAND AVE.
CERES CA
95307
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7411
  • Fax: 209-547-2083
Mailing address:
  • Phone: 209-525-7411
  • Fax: 209-547-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberS1306101650
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7617574-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: