Provider Demographics
NPI:1134982051
Name:KIEFER, ISABELLE ANNE
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:ANNE
Last Name:KIEFER
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 1:110 BODEGA AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2607
Mailing Address - Country:US
Mailing Address - Phone:707-992-8133
Mailing Address - Fax:
Practice Address - Street 1:110 BODEGA AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2607
Practice Address - Country:US
Practice Address - Phone:707-992-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician