Healthcare Provider Details

I. General information

NPI: 1780217133
Provider Name (Legal Business Name): ANNE K BJORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TAMAL PLZ STE 270
CORTE MADERA CA
94925-1162
US

IV. Provider business mailing address

100 TAMAL PLZ STE 270
CORTE MADERA CA
94925-1162
US

V. Phone/Fax

Practice location:
  • Phone: 415-758-0038
  • Fax:
Mailing address:
  • Phone: 415-758-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: