Healthcare Provider Details

I. General information

NPI: 1629394770
Provider Name (Legal Business Name): MICHELLE L KERR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W CENTER ST
YREKA CA
96097-2809
US

IV. Provider business mailing address

4021 PRUETT DR
YREKA CA
96097-9708
US

V. Phone/Fax

Practice location:
  • Phone: 530-905-3368
  • Fax:
Mailing address:
  • Phone: 530-905-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW74882
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: