Healthcare Provider Details

I. General information

NPI: 1548816267
Provider Name (Legal Business Name): FREDERICK R SAUTTER LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BLUE OAKS BLVD STE 120
ROSEVILLE CA
95747-5156
US

IV. Provider business mailing address

1070 KIRKLAND LN
LINCOLN CA
95648-7209
US

V. Phone/Fax

Practice location:
  • Phone: 707-481-7744
  • Fax: 877-349-6094
Mailing address:
  • Phone: 707-481-7744
  • Fax: 877-349-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK ROOT SAUTTER JR.
Title or Position: PRESIDENT
Credential: LCSW
Phone: 707-481-7744