Healthcare Provider Details

I. General information

NPI: 1861577751
Provider Name (Legal Business Name): WANDA FAY COSSAIRT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALNUT ST SUITE A
RED BLUFF CA
96080-3611
US

IV. Provider business mailing address

PO BOX 400
RED BLUFF CA
96080-0400
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-5631
  • Fax: 530-527-0232
Mailing address:
  • Phone: 530-527-5631
  • Fax: 530-527-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: