Healthcare Provider Details

I. General information

NPI: 1740045384
Provider Name (Legal Business Name): KATHRYN ANN VACLAVIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5668 COMO CIR
WOODLAND HILLS CA
91367-6258
US

IV. Provider business mailing address

5668 COMO CIR
WOODLAND HILLS CA
91367-6258
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-0353
  • Fax:
Mailing address:
  • Phone: 213-268-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: