Healthcare Provider Details

I. General information

NPI: 1356957815
Provider Name (Legal Business Name): JORDYN DEDINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HOWE AVE STE 207
SACRAMENTO CA
95825-3364
US

IV. Provider business mailing address

9544 BAYPOINT WAY
ELK GROVE CA
95624-6003
US

V. Phone/Fax

Practice location:
  • Phone: 916-676-0488
  • Fax:
Mailing address:
  • Phone: 916-757-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69326
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: