1053925404 NPI number — MRS. ALISON POFF RYDQUIST LMFT

Table of content: MRS. ALISON POFF RYDQUIST LMFT (NPI 1053925404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053925404 NPI number — MRS. ALISON POFF RYDQUIST LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYDQUIST
Provider First Name:
ALISON
Provider Middle Name:
POFF
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYDQUIST
Provider Other First Name:
ALISON
Provider Other Middle Name:
POFF
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053925404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 OAKDALE RD STE H2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95355-2256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-220-3649
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 OAKDALE RD STE H2
Provider Second Line Business Practice Location Address:
PMB 408
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95355-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-220-3649
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  138619 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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