Healthcare Provider Details

I. General information

NPI: 1053273227
Provider Name (Legal Business Name): SEED AND SOIL COLLECTIVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18990 COYOTE VALLEY RD STE 15
HIDDEN VALLEY LAKE CA
95467-8339
US

IV. Provider business mailing address

18990 COYOTE VALLEY RD STE 15
HIDDEN VALLEY LAKE CA
95467-8339
US

V. Phone/Fax

Practice location:
  • Phone: 909-771-8605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DALY
Title or Position: CEO
Credential: MS CCC-SLP, CLC
Phone: 909-771-8605