Healthcare Provider Details

I. General information

NPI: 1952490419
Provider Name (Legal Business Name): CHERYL L DUERKSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S FAIRWAY ST
VISALIA CA
93277-8109
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-6880
  • Fax:
Mailing address:
  • Phone: 559-737-4669
  • Fax: 559-737-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: