Healthcare Provider Details

I. General information

NPI: 1417423252
Provider Name (Legal Business Name): KAYLA HAUPT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BELLE AVE
SAN RAFAEL CA
94901-2204
US

IV. Provider business mailing address

310 NOVA ALBION WAY
SAN RAFAEL CA
94903-3523
US

V. Phone/Fax

Practice location:
  • Phone: 415-485-2420
  • Fax:
Mailing address:
  • Phone: 415-492-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: