Healthcare Provider Details

I. General information

NPI: 1922528256
Provider Name (Legal Business Name): MR. IAN DAVID WINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

IV. Provider business mailing address

564 S DORA ST STE D
UKIAH CA
95482-5465
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW139790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: