Provider Demographics
NPI:1356070502
Name:KOSKINEN, KAREN LYNN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:KOSKINEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32864 CELESTE WAY
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9618
Mailing Address - Country:US
Mailing Address - Phone:951-514-7497
Mailing Address - Fax:
Practice Address - Street 1:32864 CELESTE WAY
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9618
Practice Address - Country:US
Practice Address - Phone:951-514-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical