Healthcare Provider Details

I. General information

NPI: 1891707717
Provider Name (Legal Business Name): VICKI TALLADINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 EUREKA WAY
REDDING CA
96001-0435
US

IV. Provider business mailing address

2810 AMETHYST WAY
REDDING CA
96003-3329
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-8616
  • Fax: 530-244-7547
Mailing address:
  • Phone: 530-241-8616
  • Fax: 530-244-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: