Healthcare Provider Details

I. General information

NPI: 1750865663
Provider Name (Legal Business Name): CHRISTINA PATTERSON M.A., ED.S, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E VINE ST
LODI CA
95240-3148
US

IV. Provider business mailing address

1305 E VINE ST
LODI CA
95240-3179
US

V. Phone/Fax

Practice location:
  • Phone: 209-331-7085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: