1780807602 NPI number — MS. JENNIFER ANNE ALEXANDER M.A. PSYCHOLOGY

Table of content: MS. JENNIFER ANNE ALEXANDER M.A. PSYCHOLOGY (NPI 1780807602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780807602 NPI number — MS. JENNIFER ANNE ALEXANDER M.A. PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
JENNIFER
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOND-ALEXANDER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ALEXANDER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. PSYCHOLOGY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780807602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95619-1987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-391-9918
Provider Business Mailing Address Fax Number:
530-626-2589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4250 FOWLER LN
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
DIAMOND SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95619-9781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-391-9918
Provider Business Practice Location Address Fax Number:
530-626-2589
Provider Enumeration Date:
04/10/2007

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:  46533 , 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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