Provider Demographics
NPI:1306189782
Name:VIKSTROM, KAREN (MS, CGC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VIKSTROM
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 NUT TREE RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4100
Mailing Address - Country:US
Mailing Address - Phone:530-341-3553
Mailing Address - Fax:707-624-8001
Practice Address - Street 1:1020 NUT TREE RD
Practice Address - Street 2:SUITE 390
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:530-231-3553
Practice Address - Fax:707-624-8001
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000455170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS