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General NPI Number Information
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NPI Number | 1235682089
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Entity Type | Individual
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Provider Name | MRS. JENNIFER PARKER HACKETT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-4238
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 10259 STAFFORD ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3045
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Country | US
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Telephone | 951-836-8622
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13343
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License Number State | SC
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