Healthcare Provider Details

I. General information

NPI: 1467375188
Provider Name (Legal Business Name): NICA R POZNANOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 ILLINOIS AVE
SANTA ROSA CA
95401-3613
US

IV. Provider business mailing address

1967 ILLINOIS AVE
SANTA ROSA CA
95401-3613
US

V. Phone/Fax

Practice location:
  • Phone: 707-494-2197
  • Fax:
Mailing address:
  • Phone: 707-494-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: