Provider Demographics
NPI:1154724383
Name:FAGERSTROM, KAREN MICHELLE (PSYD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:FAGERSTROM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 COLOMA RD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4457
Mailing Address - Country:US
Mailing Address - Phone:916-709-1170
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:SUITE 605
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-709-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist