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General NPI Number Information
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NPI Number | 1528694601
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Entity Type | Individual
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Provider Name | JENNALEE SHEA WOOLDRIDGE PHD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 12526 HIGH BLUFF DR STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92130-2067
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Country | US
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Telephone | 619-432-2857
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 LA JOLLA VILLAGE DR # 116B
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City | SAN DIEGO
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State | CA
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Zip | 92161-0002
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Country | US
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Telephone |
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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 | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 31357
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License Number State | CA
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