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General NPI Number Information
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NPI Number | 1063288561
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Entity Type | Individual
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Provider Name | JONATHAN TENNISON ED.S., NCSP, LEP
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Gender | Male
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 4192 PIEDMONT AVE
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City | OAKLAND
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State | CA
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Zip | 94611-5133
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Country | US
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Telephone | 512-565-0187
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20703
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City | OAKLAND
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State | CA
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Zip | 94620-0703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 4358
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License Number State | CA
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