Healthcare Provider Details

I. General information

NPI: 1336971142
Provider Name (Legal Business Name): KATELYN ALICIA STANTON RBT
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: KATELYN ALICIA GHIRINGHELLI

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 ELM ST
NAPA CA
94559-3742
US

IV. Provider business mailing address

1792 ELM ST
NAPA CA
94559-3742
US

V. Phone/Fax

Practice location:
  • Phone: 707-225-7678
  • Fax:
Mailing address:
  • Phone: 707-225-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1185376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: