Healthcare Provider Details

I. General information

NPI: 1124993753
Provider Name (Legal Business Name): JENNIFER LYNNE KLEIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE STEPHENS PSYD

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BETTY LN
ATHERTON CA
94027-5401
US

IV. Provider business mailing address

6 BETTY LN
ATHERTON CA
94027-5401
US

V. Phone/Fax

Practice location:
  • Phone: 318-453-9711
  • Fax:
Mailing address:
  • Phone: 318-453-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: