Healthcare Provider Details

I. General information

NPI: 1730253899
Provider Name (Legal Business Name): JENNIFER BRIDGET GODDARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 JUANA MARIA AVE
SANTA BARBARA CA
93103-2714
US

IV. Provider business mailing address

617 GARDEN ST
SANTA BARBARA CA
93101-1664
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-5021
  • Fax:
Mailing address:
  • Phone: 805-884-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: