Healthcare Provider Details

I. General information

NPI: 1598871915
Provider Name (Legal Business Name): TINA KLATT ROSOLACK TRAXLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

IV. Provider business mailing address

5445 LAUREL HILLS DR
SACRAMENTO CA
95841-3105
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-5100
  • Fax:
Mailing address:
  • Phone: 916-609-5100
  • Fax: 916-609-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number19137
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 19137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: