Healthcare Provider Details

I. General information

NPI: 1992965099
Provider Name (Legal Business Name): LAURA C JENSEN NORBERG MM, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LA CASA VIA STE 205
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

931 WOODLAND DR
SAN RAMON CA
94582-2336
US

V. Phone/Fax

Practice location:
  • Phone: 925-464-3916
  • Fax:
Mailing address:
  • Phone: 925-817-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: