Healthcare Provider Details

I. General information

NPI: 1053033571
Provider Name (Legal Business Name): KATE ANNE RAYMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 1ST ST
WOODLAND CA
95695-4023
US

IV. Provider business mailing address

216 F ST # 62
DAVIS CA
95616-4515
US

V. Phone/Fax

Practice location:
  • Phone: 530-662-2211
  • Fax:
Mailing address:
  • Phone: 530-902-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number96269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: