Healthcare Provider Details

I. General information

NPI: 1326289588
Provider Name (Legal Business Name): TAWNY L KUCK RASI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 JULIESSE AVE
SACRAMENTO CA
95815-1803
US

IV. Provider business mailing address

1550 JULIESSE AVE
SACRAMENTO CA
95815-1803
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-4811
  • Fax: 916-921-6604
Mailing address:
  • Phone: 916-609-4811
  • Fax: 916-921-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberK0508171433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: