Healthcare Provider Details

I. General information

NPI: 1487972238
Provider Name (Legal Business Name): JENNIFER TOLER SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 W SHAW AVE
FRESNO CA
93711-3416
US

IV. Provider business mailing address

1734 W SHAW AVE
FRESNO CA
93711-3416
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5920
  • Fax: 559-439-2214
Mailing address:
  • Phone: 559-439-5920
  • Fax: 559-439-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: