Healthcare Provider Details

I. General information

NPI: 1497696645
Provider Name (Legal Business Name): TAMMY SWAHN CLELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1414 4TH ST
SAN RAFAEL CA
94901-2857
US

IV. Provider business mailing address

339 JACQUELYN LN
PETALUMA CA
94952-5301
US

V. Phone/Fax

Practice location:
  • Phone: 858-228-7318
  • Fax:
Mailing address:
  • Phone: 858-228-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: