Healthcare Provider Details

I. General information

NPI: 1417088485
Provider Name (Legal Business Name): CORRI CHADWICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 ELK GROVE FLORIN RD
ELK GROVE CA
95624-1801
US

IV. Provider business mailing address

6615 VALLEY HI DR
SACRAMENTO CA
95823-7076
US

V. Phone/Fax

Practice location:
  • Phone: 916-686-5085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: