Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY31252 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY31252 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1043651722 |
---|---|
Provider Name | Dr. Kaitlin Marie Venema |
First Address | Petaluma, CA 94954-5473 |
Second Address | Petaluma, CA 94954-5473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2013 |
Last Update Date | 03/01/2022 |