Mary Champion

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

LEP4613 Issued in CA

Practice address

5340 Skylane Blvd
Santa Rosa, CA 95403-8246

Phone

(707) 524-2711

NPI assigned

Jun 18, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sonoma County Office of Education

  • Local Education Agency (LEA)
  • Santa Rosa, CA
  • NPI 1194840280
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1457248916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 MIDWAY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054956",
            "telephone_number": "858-736-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5340 SKYLANE BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038246",
            "telephone_number": "707-524-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPION",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT96596",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "LEP4613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frederick J. Challoner, MD
• Mary Ellen Sullivan Chalmers, D.M.D.
• Mary Chamberlain, PT
• Kayla Michele Champion
• Lorraine A Champion, MD
• David Tai-Way Chan, MD
• Henry Chan, PHARM-D
• Kaila Azzura Chan, FNP-C
• Sophia Huimin Chan, MD
• Darien Marie Chandler, F.N.P.

• School Psychologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• School Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.