Healthcare Provider Details

I. General information

NPI: 1174769095
Provider Name (Legal Business Name): JENNIFER ORTHWEIN JD, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

IV. Provider business mailing address

584 CASTRO ST # 867
SAN FRANCISCO CA
94114-2512
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: