Healthcare Provider Details

I. General information

NPI: 1457584567
Provider Name (Legal Business Name): JENNA N SANTOYO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NORMANDY LN
LODI CA
95242-3434
US

IV. Provider business mailing address

1800 NORMANDY LN
LODI CA
95242-3434
US

V. Phone/Fax

Practice location:
  • Phone: 209-712-1683
  • Fax:
Mailing address:
  • Phone: 209-712-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: