Provider Demographics
NPI:1043654056
Name:KAISER, STEPHANIE CHIQUILLO (LMFT, PPSC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CHIQUILLO
Last Name:KAISER
Suffix:
Gender:F
Credentials:LMFT, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 LOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-8847
Mailing Address - Country:US
Mailing Address - Phone:916-233-7620
Mailing Address - Fax:
Practice Address - Street 1:360 NEVADA ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3779
Practice Address - Country:US
Practice Address - Phone:916-233-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 94554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist