Healthcare Provider Details

I. General information

NPI: 1700914280
Provider Name (Legal Business Name): JANETTE ANDER JAMESON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax: 209-558-8031
Mailing address:
  • Phone: 209-558-4595
  • Fax: 209-558-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: