Healthcare Provider Details

I. General information

NPI: 1972640670
Provider Name (Legal Business Name): MICKI JEAN WINEBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICKI JEAN SINCLAIR

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

IV. Provider business mailing address

260 COHASSET RD STE 120
CHICO CA
95926-2282
US

V. Phone/Fax

Practice location:
  • Phone: 530-894-5933
  • Fax: 530-877-1978
Mailing address:
  • Phone: 530-894-5933
  • Fax: 530-877-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: