Healthcare Provider Details

I. General information

NPI: 1811267115
Provider Name (Legal Business Name): JENNIFER L GILDNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SHIELDS AVENUE 219 NORTH HALL, UC DAVIS
DAVIS CA
95616
US

IV. Provider business mailing address

ONE SHIELDS AVENUE CAPS - UNIVERSITY OF CALIFORNIA, DAVIS
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-0871
  • Fax: 530-752-9923
Mailing address:
  • Phone: 530-752-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP5268
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY24958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: