MEDICARE: CHARLOTTE VANNOPPEN

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
1	1041C0700X	Clinical Social Worker	134495	CA
2	225400000X	Rehabilitation Practitioner
3	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1710660725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE VANNOPPEN

Provider Business Mailing Address
First Line	:	480 TESCONI CIR STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 TESCONI CIR STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4691
Country	:	US
Telephone Number	:	707-206-7268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	12/03/2025

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Directions to “ CHARLOTTE VANNOPPEN ” Practice Location

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