Healthcare Provider Details

I. General information

NPI: 1679967947
Provider Name (Legal Business Name): STEPHEN REDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 IRWIN LN
SANTA ROSA CA
95401-5603
US

IV. Provider business mailing address

12755 N HIGHWAY 88
LODI CA
95240-9323
US

V. Phone/Fax

Practice location:
  • Phone: 707-360-1500
  • Fax: 707-360-1958
Mailing address:
  • Phone: 707-340-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: