MEDICARE: KATELYN MARIE DALTON

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	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1790202638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MARIE DALTON

Provider Business Mailing Address
First Line	:	930 S MOUNT VERNON AVE STE 900
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3976
Country	:	US
Telephone Number	:	909-366-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 S MOUNT VERNON AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-3928
Country	:	US
Telephone Number	:	909-366-9344
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	01/27/2025

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