1629044045 NPI number — MRS. KAREN L. DIETER KAPPHAHN LCSW

Table of content: MRS. KAREN L. DIETER KAPPHAHN LCSW (NPI 1629044045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629044045 NPI number — MRS. KAREN L. DIETER KAPPHAHN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIETER KAPPHAHN
Provider First Name:
KAREN
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIETER
Provider Other First Name:
KAREN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629044045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUSANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-249-6410
Provider Business Mailing Address Fax Number:
530-252-6595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 S ROOP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-257-6411
Provider Business Practice Location Address Fax Number:
530-257-6411
Provider Enumeration Date:
02/25/2006

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: 101YM0800X , with the licence number:  LCS 21751 , 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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