=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770081531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE STUDZINSKI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2018
-----------------------------------------------------
Last Update Date | 01/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 768 PLEASANT VALLEY RD
-----------------------------------------------------
City | DIAMOND SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95619-9260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-621-6230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7550 FOLSOM AUBURN RD APT 609
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-1780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PCC14730
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | IMF95542
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------