Healthcare Provider Details

I. General information

NPI: 1992636914
Provider Name (Legal Business Name): HEATHER KLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 LA SALLE AVE STE 205
OAKLAND CA
94611-2802
US

IV. Provider business mailing address

407 S E ST
LOMPOC CA
93436-7914
US

V. Phone/Fax

Practice location:
  • Phone: 805-430-9963
  • Fax:
Mailing address:
  • Phone: 559-380-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW119999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: