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General NPI Number Information
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NPI Number | 1740073923
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Entity Type | Individual
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Provider Name | KALISSA JARDINE PPS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1928 W NICOLET ST
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City | BANNING
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State | CA
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Zip | 92220-4032
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Country | US
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Telephone | 951-922-0254
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 W REDLANDS BLVD APT 3B
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City | REDLANDS
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State | CA
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Zip | 92373-6231
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Country | US
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Telephone | 909-712-7534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 230139063
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License Number State | CA
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