MEDICARE: DR. JODI SUZANNE COUICK

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	103TS0200X	School Psychologist		CA
2	103TC0700X	Clinical Psychologist	PSY12597	CA

General Provider Information

NPI Number	:	1730558909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI SUZANNE COUICK

Provider Business Mailing Address
First Line	:	3000 PARKER RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-2742
Country	:	US
Telephone Number	:	510-915-2654
Fax Number	:	510-724-8829

Provider Business Practice Location Address
First Line	:	3000 PARKER RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-2742
Country	:	US
Telephone Number	:	510-915-2654
Fax Number	:	510-724-8829

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/22/2020

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