Healthcare Provider Details

I. General information

NPI: 1144133950
Provider Name (Legal Business Name): SEBASTOPOL INDEPENDENT CHARTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HWY 116 N
SEBASTOPOL CA
95472-2802
US

IV. Provider business mailing address

1111 HWY 116 N
SEBASTOPOL CA
95472-2802
US

V. Phone/Fax

Practice location:
  • Phone: 707-824-9700
  • Fax:
Mailing address:
  • Phone: 707-824-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLI LEWIS
Title or Position: DIRECTOR OF STUDENT SUPPORT SERVICE
Credential: MM/MS/ESN
Phone: 707-824-9700