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General NPI Number Information
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NPI Number | 1285111997
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Entity Type | Organization
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Legal Business Name | SIERRA NEVADA NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 900 E MAIN ST STE 106
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5853
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Country | US
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Telephone | 530-446-6164
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Fax | 530-446-6377
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Provider Business Mailing Address
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Address Line | 177 BOVET RD FL 6
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City | SAN MATEO
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State | CA
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Zip | 94402-3122
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Country | US
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Telephone | 888-570-1020
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Fax | 888-384-0984
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Authorized Official
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Title or Position | PROVIDER
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Name | JODI D SNYDER
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Credential | PSYD
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Telephone | 530-446-6164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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