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General NPI Number Information
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NPI Number | 1376663161
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Entity Type | Individual
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Provider Name | KAREN A BOLTWOOD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 2020 COFFEE RD STE A5
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City | MODESTO
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State | CA
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Zip | 95355-2407
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Country | US
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Telephone | 209-248-5505
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Fax | 855-821-1966
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Provider Business Mailing Address
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Address Line | 828 COBBLESTONE CIR
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City | MODESTO
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State | CA
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Zip | 95355-4501
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Country | US
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Telephone | 209-572-0511
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Fax | 209-526-0908
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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 | 53088
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License Number State | CA
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