Individual
KIRSTIE WICHTENDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
3585 HAWVER RD., SAN ANDREAS, CA 95249-9524
(209) 754-1249
Mailing address
PO BOX 1144, SAN ANDREAS, CA 95249-1144
(209) 754-1249
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40011
CA
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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