Healthcare Provider Details

I. General information

NPI: 1235346156
Provider Name (Legal Business Name): KIRSTEN ACKER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST SUITE 259
OAKLAND CA
94601-3424
US

IV. Provider business mailing address

3301 E 12TH ST SUITE 259
OAKLAND CA
94601-3424
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-9030
  • Fax: 510-269-9031
Mailing address:
  • Phone: 510-269-9030
  • Fax: 510-269-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY26425
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: