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General NPI Number Information
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NPI Number | 1457533630
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Entity Type | Individual
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Provider Name | CHAD E KIEDROWSKI
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Gender | Male
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 10776 FREMONT ST
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City | YUCAIPA
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State | CA
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Zip | 92399-9630
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Country | US
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Telephone | 951-797-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 10776 FREMONT ST
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City | YUCAIPA
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State | CA
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Zip | 92399-9630
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Country | US
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Telephone | 951-797-0114
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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 | LMFT87428
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 45168
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License Number State | CA
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