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NPI Code Detail

MEDICARE: DAELAN BOUTWELL

MEDICARE: DAELAN BOUTWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1811856081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAELAN BOUTWELL
Provider Business Mailing Address
First Line : 19 OAK AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2720
Country : US
Telephone Number : 415-515-2571
Fax Number :
Provider Business Practice Location Address
First Line : 3824 BUELL ST STE A2
Second Line :
City : OAKLAND
State : CA
Zip : 94619-2861
Country : US
Telephone Number : 209-877-7844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Directions to “ DAELAN BOUTWELL ” Practice Location

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