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NPI Code Detail

MEDICARE: DR. MARCIA JELLA' RENNIE PHD

MEDICARE:  DR. MARCIA JELLA' RENNIE  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY 22214CA
2103TC2200XClinical Child & Adolescent PsychologistPSY 22214CA

General Provider Information

NPI Number : 1750527222
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCIA JELLA' RENNIE PHD
Provider Business Mailing Address
First Line : 825 ZION ST
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2922
Country : US
Telephone Number : 530-265-2199
Fax Number : 530-265-2619
Provider Business Practice Location Address
First Line : 825 ZION ST
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-2922
Country : US
Telephone Number : 530-265-2199
Fax Number : 530-265-2619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2009
Last Update Date : 01/05/2009

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Directions to “ DR. MARCIA JELLA' RENNIE PHD” Practice Location

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