Healthcare Provider Details

I. General information

NPI: 1356439236
Provider Name (Legal Business Name): JENNIFER STOPHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 BEACH BLVD STE 155
WESTMINSTER CA
92683-4453
US

IV. Provider business mailing address

2825 WILLOW AVE
FULLERTON CA
92835-2836
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-7556
  • Fax:
Mailing address:
  • Phone: 714-896-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: