Healthcare Provider Details

I. General information

NPI: 1457104606
Provider Name (Legal Business Name): ISABELLA KULLANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/02/2026
Certification Date: 02/04/2026
Deactivation Date: 03/02/2026
Reactivation Date: 06/02/2026

III. Provider practice location address

601 COURT ST STE 205
JACKSON CA
95642-2163
US

IV. Provider business mailing address

601 COURT ST STE 205
JACKSON CA
95642-2163
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-1980
  • Fax:
Mailing address:
  • Phone: 209-257-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: