Healthcare Provider Details

I. General information

NPI: 1871233833
Provider Name (Legal Business Name): STEFANI KODA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E SHAW AVE
FRESNO CA
93710-8024
US

IV. Provider business mailing address

4086 N ATLAS WAY
FRESNO CA
93705-1747
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0490
  • Fax: 559-320-0494
Mailing address:
  • Phone: 559-797-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105573
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: