Provider Demographics
NPI:1063529980
Name:REKDAHL, KRISTINE SELBY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:SELBY
Last Name:REKDAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:SELBY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9837 FOLSOM BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1356
Mailing Address - Country:US
Mailing Address - Phone:916-856-5164
Mailing Address - Fax:916-856-5708
Practice Address - Street 1:9837 FOLSOM BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1356
Practice Address - Country:US
Practice Address - Phone:916-856-5164
Practice Address - Fax:916-856-5708
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW LCS 4331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker