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General NPI Number Information
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NPI Number | 1295283919
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Entity Type | Individual
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Provider Name | JENNIFER SEIDEN SUDRC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 300 HARVEY WEST BLVD
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2103
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Country | US
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Telephone | 831-230-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 4011 GLENWOOD DR
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City | SCOTTS VALLEY
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State | CA
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Zip | 95066-2621
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Country | US
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Telephone | 831-251-2788
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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