Provider Demographics
NPI:1255119418
Name:STOLTE, TAKEISHA RENEE (BA)
Entity type:Individual
Prefix:MRS
First Name:TAKEISHA
Middle Name:RENEE
Last Name:STOLTE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TAKEISHA
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3360 N HIGHWAY 59 STE K
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9405
Mailing Address - Country:US
Mailing Address - Phone:209-725-2125
Mailing Address - Fax:209-726-4430
Practice Address - Street 1:3360 N HIGHWAY 59 STE K
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9405
Practice Address - Country:US
Practice Address - Phone:209-725-2125
Practice Address - Fax:209-726-4430
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker