Healthcare Provider Details

I. General information

NPI: 1821601071
Provider Name (Legal Business Name): LAURA PLUCKHAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 W KETTLEMAN LN # 1020
LODI CA
95242-4121
US

IV. Provider business mailing address

2415 W KETTLEMAN LN # 1020
LODI CA
95242-4121
US

V. Phone/Fax

Practice location:
  • Phone: 916-668-0379
  • Fax:
Mailing address:
  • Phone: 916-668-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: