=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154700292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LYNN HOOPER CADC II
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2015
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 891 MOUNTAIN RANCH RD
-----------------------------------------------------
City | SAN ANDREAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95249-9713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-754-2817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11104 QUAIL DR
-----------------------------------------------------
City | PINE GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95665-9782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-761-0619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------