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NPI Code Detail

MEDICARE: CASSIDY COULTER

MEDICARE: CASSIDY COULTER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1730021684
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDY COULTER
Provider Business Mailing Address
First Line : 2400 LINCOLN OAK DR
Second Line :
City : MODESTO
State : CA
Zip : 95355-9435
Country : US
Telephone Number : 559-512-3526
Fax Number : 559-272-0026
Provider Business Practice Location Address
First Line : 2400 LINCOLN OAK DR
Second Line :
City : MODESTO
State : CA
Zip : 95355-9435
Country : US
Telephone Number : 559-512-3526
Fax Number : 559-272-0026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ CASSIDY COULTER ” Practice Location

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