Healthcare Provider Details

I. General information

NPI: 1326879297
Provider Name (Legal Business Name): JILL JOSEPHINE GARLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 S STATE ST STE 103
UKIAH CA
95482-5833
US

IV. Provider business mailing address

776 S STATE ST STE 103
UKIAH CA
95482-5833
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-4915
  • Fax:
Mailing address:
  • Phone: 707-463-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: