1780729533 NPI number — MRS. SUE ANN MICHI TAKEMOTO MSW

Table of content: MRS. SUE ANN MICHI TAKEMOTO MSW (NPI 1780729533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780729533 NPI number — MRS. SUE ANN MICHI TAKEMOTO MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAKEMOTO
Provider First Name:
SUE ANN
Provider Middle Name:
MICHI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAKEMOTO
Provider Other First Name:
MICHI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780729533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96001-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-241-1716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2485 OLD EUREKA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-0336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-355-5131
Provider Business Practice Location Address Fax Number:
530-244-1546
Provider Enumeration Date:
02/20/2007

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: 1041C0700X , with the licence number:  LCS10897 , 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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