MEDICARE: KIRSTEN JAVERNICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	7798812462	CA

General Provider Information

NPI Number	:	1114884954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN JAVERNICK

Provider Business Mailing Address
First Line	:	4128 FEATHER RIVER DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-6541
Country	:	US
Telephone Number	:	209-953-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 W SWAIN RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-4055
Country	:	US
Telephone Number	:	209-953-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/06/2026

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