Healthcare Provider Details

I. General information

NPI: 1962562330
Provider Name (Legal Business Name): STACEY JEAN ROHRER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 FAIR OAKS BLVD # 14
SACRAMENTO CA
95825-4708
US

IV. Provider business mailing address

2345 FAIR OAKS BLVD # 14
SACRAMENTO CA
95825-4708
US

V. Phone/Fax

Practice location:
  • Phone: 916-480-6862
  • Fax: 916-480-6844
Mailing address:
  • Phone: 916-480-6862
  • Fax: 916-480-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 20413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: