Provider Demographics
NPI:1871233833
Name:KODA, STEFANI (ASW)
Entity Type:Individual
Prefix:MISS
First Name:STEFANI
Middle Name:
Last Name:KODA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 E SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8024
Mailing Address - Country:US
Mailing Address - Phone:559-320-0490
Mailing Address - Fax:559-320-0494
Practice Address - Street 1:1551 E SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8024
Practice Address - Country:US
Practice Address - Phone:559-320-0490
Practice Address - Fax:559-320-0494
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical