Individual
TRACY ROUTH LAUTENSLAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
406 SUNRISE AVE, ROSEVILLE, CA 95661-4106
(530) 321-3399
Mailing address
406 SUNRISE AVE, ROSEVILLE, CA 95661-4106
(530) 321-3399
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
30908
CA
Other
Enumeration date
04/22/2021
Last updated
04/22/2021
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