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NPI Code Detail

MEDICARE: MRS. STEPHANIE CHIQUILLO KAISER LMFT, PPSC

MEDICARE: MRS. STEPHANIE CHIQUILLO KAISER LMFT, PPSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistLMFT 94554CA

General Provider Information

NPI Number : 1043654056
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE CHIQUILLO KAISER LMFT, PPSC
Provider Business Mailing Address
First Line : 2320 LOCKTON DR
Second Line :
City : ROSEVILLE
State : CA
Zip : 95747-8847
Country : US
Telephone Number : 916-233-7620
Fax Number :
Provider Business Practice Location Address
First Line : 360 NEVADA ST
Second Line :
City : AUBURN
State : CA
Zip : 95603-3779
Country : US
Telephone Number : 916-233-7620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2013
Last Update Date : 04/17/2024

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