=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205732914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA CHRISTINE FODDRILL MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3894 E GETTYSBURG AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93726-0901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-454-0822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 636 E NORTHRIDGE DR
-----------------------------------------------------
City | DINUBA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93618-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-464-1345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | APCC24036
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------