1053474387 NPI number — MRS. JENNIFER ELIZABETH STUCKEY MFT

Table of content: MRS. JENNIFER ELIZABETH STUCKEY MFT (NPI 1053474387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053474387 NPI number — MRS. JENNIFER ELIZABETH STUCKEY MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUCKEY
Provider First Name:
JENNIFER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMITZ
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFTI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053474387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 2094
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POB 2094
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CLARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-688-3623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  41047 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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