Healthcare Provider Details

I. General information

NPI: 1306771266
Provider Name (Legal Business Name): DR. JERRY DAMPIER, LICENSED PSYCHOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 HOPPER AVE
SANTA ROSA CA
95403-1606
US

IV. Provider business mailing address

1163 HOPPER AVE APT 42
SANTA ROSA CA
95403-1636
US

V. Phone/Fax

Practice location:
  • Phone: 415-866-9647
  • Fax: 415-866-9647
Mailing address:
  • Phone: 415-866-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY DAMPIER
Title or Position: PRESIDENT/PRIVATE PRACTICE OWNER
Credential: PSYCHOLOGIST
Phone: 415-866-9647