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General NPI Number Information
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NPI Number | 1417575499
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Entity Type | Individual
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Provider Name | JENNA KARLSBERG BENNETT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 221 N 3RD ST # 443
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City | BURBANK
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State | CA
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Zip | 91502-1202
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Country | US
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Telephone | 424-253-4656
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N 3RD ST # 443
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City | BURBANK
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State | CA
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Zip | 91502-1202
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Country | US
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Telephone | 424-253-4656
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY34258
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License Number State | CA
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