Healthcare Provider Details

I. General information

NPI: 1548190234
Provider Name (Legal Business Name): JADYN MCDANIEL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 FOLSOM BLVD
SACRAMENTO CA
95826-2473
US

IV. Provider business mailing address

7457 MOON DREAM WAY
ROSEVILLE CA
95747-9400
US

V. Phone/Fax

Practice location:
  • Phone: 916-701-9258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: