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General NPI Number Information
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NPI Number | 1730334525
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Entity Type | Individual
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Provider Name | SHIRLEY ANN IKENZE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 1035 TENNESSEE ST
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City | VALLEJO
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State | CA
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Zip | 94590-4547
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Country | US
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Telephone | 707-552-5173
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6211
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City | VALLEJO
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State | CA
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Zip | 94591-6211
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Country | US
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Telephone | 707-552-5173
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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