1699052837 NPI number — MISS JENNIFER LYNN MANDERSCHEID M.A MFT

Table of content: MISS JENNIFER LYNN MANDERSCHEID M.A MFT (NPI 1699052837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699052837 NPI number — MISS JENNIFER LYNN MANDERSCHEID M.A MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANDERSCHEID
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699052837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 VILLAGE PARK WAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-1994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-633-6760
Provider Business Mailing Address Fax Number:
760-487-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 VILLAGE PARK WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-1994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-633-6760
Provider Business Practice Location Address Fax Number:
760-487-5453
Provider Enumeration Date:
11/15/2011

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:  50683 , 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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