Healthcare Provider Details

I. General information

NPI: 1962395061
Provider Name (Legal Business Name): KRISTINA RENN PPSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11638 COLFAX HWY
GRASS VALLEY CA
95945-8805
US

IV. Provider business mailing address

11638 COLFAX HWY
GRASS VALLEY CA
95945-8805
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-8456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240225061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: