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General NPI Number Information
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NPI Number | 1376962308
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Entity Type | Individual
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Provider Name | JACKELIN CHAVEZ RUEDA
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Gender | Female
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 1920 TIENDA DR. #101
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City | LODI
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State | CA
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Zip | 95242
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Country | US
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Telephone | 209-647-0398
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Fax | 209-625-0492
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Provider Business Mailing Address
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Address Line | P.O. BOX 6779
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City | STOCKTON
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State | CA
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Zip | 95206
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Country | US
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Telephone | 209-368-2532
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Fax | 209-625-0492
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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 | 101Y00000X
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Taxonomy Name | 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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