Healthcare Provider Details

I. General information

NPI: 1306757687
Provider Name (Legal Business Name): JENNA HALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 WATERTROUGH RD
SEBASTOPOL CA
95472-4647
US

IV. Provider business mailing address

193 WEBSTER ST
PETALUMA CA
94952-2450
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-7446
  • Fax:
Mailing address:
  • Phone: 707-696-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: