Healthcare Provider Details

I. General information

NPI: 1891605812
Provider Name (Legal Business Name): REANNA SUE CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SHAW AVE STE 105
CLOVIS CA
93611-4072
US

IV. Provider business mailing address

8279 N 8TH ST
FRESNO CA
93720-2215
US

V. Phone/Fax

Practice location:
  • Phone: 559-314-0623
  • Fax:
Mailing address:
  • Phone: 559-260-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: