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General NPI Number Information
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NPI Number | 1336341031
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Entity Type | Individual
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Provider Name | REGINA ANN NORDMAN MFT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 315 W PINE ST SUITE #4
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City | LODI
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State | CA
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Zip | 95240-2047
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Country | US
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Telephone | 209-481-1441
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Fax | 209-340-1950
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Provider Business Mailing Address
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Address Line | 20201 WINDWOOD DR
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City | WOODBRIDGE
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State | CA
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Zip | 95258-9075
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Country | US
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Telephone | 209-481-1441
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Fax | 209-340-1950
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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 | MFC 40091
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License Number State | CA
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