Healthcare Provider Details

I. General information

NPI: 1023587078
Provider Name (Legal Business Name): JESSICA CLIFTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 ROUND BARN BLVD STE 200
SANTA ROSA CA
95403-0991
US

IV. Provider business mailing address

3558 ROUND BARN BLVD STE 200
SANTA ROSA CA
95403-0991
US

V. Phone/Fax

Practice location:
  • Phone: 707-341-6829
  • Fax: 707-324-3826
Mailing address:
  • Phone: 707-341-6829
  • Fax: 707-324-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0126352
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: