Healthcare Provider Details

I. General information

NPI: 1699313965
Provider Name (Legal Business Name): JACQUELINE DUGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 04/12/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N LINCOLN ST STE A
DIXON CA
95620-3238
US

IV. Provider business mailing address

PO BOX 844
DIXON CA
95620-0844
US

V. Phone/Fax

Practice location:
  • Phone: 707-366-5246
  • Fax:
Mailing address:
  • Phone: 530-720-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: