Provider Demographics
NPI:1669669297
Name:NORDLIN, KRISTINA ANNE (MA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANNE
Last Name:NORDLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9566 DOMINION WOOD LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1182
Mailing Address - Country:US
Mailing Address - Phone:530-368-7714
Mailing Address - Fax:
Practice Address - Street 1:9566 DOMINION WOOD LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1182
Practice Address - Country:US
Practice Address - Phone:530-368-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist