Provider Demographics
NPI:1548816267
Name:FREDERICK R SAUTTER LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:FREDERICK R SAUTTER LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ROOT
Authorized Official - Last Name:SAUTTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-481-7744
Mailing Address - Street 1:1070 KIRKLAND LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7209
Mailing Address - Country:US
Mailing Address - Phone:707-481-7744
Mailing Address - Fax:877-349-6094
Practice Address - Street 1:1430 BLUE OAKS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5156
Practice Address - Country:US
Practice Address - Phone:707-481-7744
Practice Address - Fax:877-349-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-18
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty