Krystallin Stacy
Individual provider Active NPI Behavior Technician · Petaluma, CA
NPI 1104389733 · NPPES record last updated Apr 10, 2019
Key facts
- NPI
- 1104389733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 101 H St Ste L
Petaluma, CA 94952-5100 - Phone
- (866) 206-2008
- NPI assigned
- Apr 10, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
101 H St Ste L
Petaluma, CA 94952-5100
Mailing address
1771 Monarch Dr
Napa, CA 94558-1620
Other providers in Petaluma, CA
- Elizabeth Spranger
- SRM Alliance Hospital Services
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
- St. Joseph Home Care Network
- Arnella O Stafford
- Ariel N Stanford
- Thomas Spencer Stanton II
- Rebecca A Stanwyck
- Alicia Lynn Starrett
All providers in Petaluma, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.