Provider Demographics
NPI:1285877191
Name:LANDZIAK, TAMMY RAE
Entity type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:RAE
Last Name:LANDZIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3919
Mailing Address - Country:US
Mailing Address - Phone:916-613-0594
Mailing Address - Fax:
Practice Address - Street 1:6329 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-3919
Practice Address - Country:US
Practice Address - Phone:916-613-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)