Healthcare Provider Details

I. General information

NPI: 1376956177
Provider Name (Legal Business Name): KELSEY RENEE BJUGSTAD ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 CHALLENGER WAY
SANTA ROSA CA
95407-5441
US

IV. Provider business mailing address

2225 CHALLENGER WAY
SANTA ROSA CA
95407-5441
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-6900
  • Fax:
Mailing address:
  • Phone: 707-565-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: