Provider Demographics
NPI:1073736419
Name:TONNESSEN, KATHLEEN GERMAINE (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:GERMAINE
Last Name:TONNESSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 RANCHO AMIGOS RD N
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-5711
Mailing Address - Country:US
Mailing Address - Phone:949-303-8761
Mailing Address - Fax:
Practice Address - Street 1:2221 CAMINO DEL RIO S STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3611
Practice Address - Country:US
Practice Address - Phone:619-297-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF43295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist