Provider Demographics
NPI:1700428935
Name:BJORK, KERRI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LEE
Last Name:BJORK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3851
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-0966
Mailing Address - Country:US
Mailing Address - Phone:805-358-9618
Mailing Address - Fax:
Practice Address - Street 1:16125 SPANGLER PEAK RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4238
Practice Address - Country:US
Practice Address - Phone:805-358-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA911911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical