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General NPI Number Information
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NPI Number | 1679902811
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE ANDERSON MFC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 930 SHILOH RD BLDG 44, STE. G
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City | WINDSOR
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State | CA
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Zip | 95492-9659
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Country | US
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Telephone | 707-477-9769
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Fax | 707-836-1997
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Provider Business Mailing Address
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Address Line | 930 SHILOH RD BLDG 44, STE. G
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City | WINDSOR
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State | CA
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Zip | 95492-9659
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Country | US
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Telephone | 707-477-9769
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Fax | 707-836-1997
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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 | 49419
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License Number State | CA
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