Individual
KA HER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7590 SHORELINE DR, STOCKTON, CA 95219-5455
(209) 774-5251
Mailing address
7590 SHORELINE DR, STOCKTON, CA 95219-5455
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
03/23/2026
Last updated
03/23/2026
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