Basic Information
| Provider Information | |||||||||
| NPI: | 1659415156 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CEARLEY | ||||||||
| FirstName: | JANA | ||||||||
| MiddleName: | KATHLIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814997 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1585 KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934057604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814997 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 09/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT25783 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.