Healthcare Provider Details

I. General information

NPI: 1760948798
Provider Name (Legal Business Name): DYLAN KIERAN WHITLOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 SCHIRRA AVE
MATHER CA
95655-4121
US

IV. Provider business mailing address

3913 OAK VILLA CIR
CARMICHAEL CA
95608-2161
US

V. Phone/Fax

Practice location:
  • Phone: 916-213-5733
  • Fax:
Mailing address:
  • Phone: 916-213-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number174H00000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: