Provider Demographics
NPI:1790827590
Name:UKESTAD, ROYANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ROYANNE
Middle Name:
Last Name:UKESTAD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARTIN
Mailing Address - State:CA
Mailing Address - Zip Code:95046-9433
Mailing Address - Country:US
Mailing Address - Phone:408-683-4062
Mailing Address - Fax:
Practice Address - Street 1:17705 HALE AVE STE F2
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4349
Practice Address - Country:US
Practice Address - Phone:408-779-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist