Provider Demographics
NPI:1124572698
Name:KJELLANDER, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KJELLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 MISSION ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2485
Mailing Address - Country:US
Mailing Address - Phone:877-264-6747
Mailing Address - Fax:877-539-7730
Practice Address - Street 1:11801 PIERCE STREET, SUITE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3743
Practice Address - Country:US
Practice Address - Phone:877-264-6747
Practice Address - Fax:877-539-7730
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst