Healthcare Provider Details

I. General information

NPI: 1669702221
Provider Name (Legal Business Name): KRISTINA AILEEN SCHLOSSER ACSW, MHRS, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 PARKER HILL RD
SANTA ROSA CA
95404-1732
US

IV. Provider business mailing address

1821 ALBANY DR
SANTA ROSA CA
95401-3604
US

V. Phone/Fax

Practice location:
  • Phone: 707-535-0289
  • Fax:
Mailing address:
  • Phone: 707-477-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: