Healthcare Provider Details

I. General information

NPI: 1962312066
Provider Name (Legal Business Name): JENNAFER AHLBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 Q ST
RIO LINDA CA
95673-1532
US

IV. Provider business mailing address

3358 AMERICA DR
LINCOLN CA
95648-8889
US

V. Phone/Fax

Practice location:
  • Phone: 916-749-5745
  • Fax:
Mailing address:
  • Phone: 916-749-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: