Healthcare Provider Details

I. General information

NPI: 1164223715
Provider Name (Legal Business Name): JENNIFER R MARZION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 ARNOLD AVE UNIT A
MCCLELLAN CA
95652-1075
US

IV. Provider business mailing address

305 51ST ST
SACRAMENTO CA
95819-2911
US

V. Phone/Fax

Practice location:
  • Phone: 916-516-6193
  • Fax:
Mailing address:
  • Phone: 925-575-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: