Provider Demographics
NPI:1972484053
Name:THAO, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:THAO
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 1:7674 LINDSEY CT
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-9270
Mailing Address - Country:US
Mailing Address - Phone:707-298-7883
Mailing Address - Fax:
Practice Address - Street 1:7674 LINDSEY CT
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:CA
Practice Address - Zip Code:95388-9270
Practice Address - Country:US
Practice Address - Phone:707-298-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker