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General NPI Number Information
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NPI Number | 1124858519
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Entity Type | Individual
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Provider Name | BRIDGET KROHLOW
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Gender |
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2617 K ST STE 275
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City | SACRAMENTO
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State | CA
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Zip | 95816-5165
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Country | US
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Telephone | 920-716-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 904 PANORAMIC WAY
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City | BERKELEY
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State | CA
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Zip | 94704-2540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 135492
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License Number State | CA
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