Healthcare Provider Details

I. General information

NPI: 1255247599
Provider Name (Legal Business Name): JODY LYNN CLANAHAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 HALLIANA CT
BAKERSFIELD CA
93311-9344
US

IV. Provider business mailing address

1603 HALLIANA CT
BAKERSFIELD CA
93311-9344
US

V. Phone/Fax

Practice location:
  • Phone: 661-366-4461
  • Fax:
Mailing address:
  • Phone: 661-366-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number220203938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: