Healthcare Provider Details

I. General information

NPI: 1821651605
Provider Name (Legal Business Name): MS. DANA ELLEN JEFFFREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 LILIBET AVE
SACRAMENTO CA
95826-5413
US

IV. Provider business mailing address

9260 LILIBET AVENUE
SACRAMENTO CA
95826
US

V. Phone/Fax

Practice location:
  • Phone: 916-205-7608
  • Fax:
Mailing address:
  • Phone: 916-205-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2432
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: