Healthcare Provider Details

I. General information

NPI: 1841799111
Provider Name (Legal Business Name): KALE RYAN HARDWICK CADTP5984ASW137360
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 MONROE ST
INDIO CA
92201-3096
US

IV. Provider business mailing address

44199 MONROE ST
INDIO CA
92201-3096
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8262
  • Fax:
Mailing address:
  • Phone: 607-863-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW137360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR5984
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR5984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: