Healthcare Provider Details

I. General information

NPI: 1194208983
Provider Name (Legal Business Name): TIFFANY DANIELLE SICKLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 MAGNOLIA ST
LOOMIS CA
95650-8921
US

IV. Provider business mailing address

PO BOX 1403
LOOMIS CA
95650-1403
US

V. Phone/Fax

Practice location:
  • Phone: 916-652-5802
  • Fax:
Mailing address:
  • Phone: 916-652-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: