Provider Demographics
NPI:1912015421
Name:LINK, ANN LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:LINK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3723
Mailing Address - Country:US
Mailing Address - Phone:916-489-6082
Mailing Address - Fax:916-489-5624
Practice Address - Street 1:5801 NORTH AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3723
Practice Address - Country:US
Practice Address - Phone:916-489-6082
Practice Address - Fax:916-489-5624
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL103580Medicare UPIN