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General NPI Number Information
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NPI Number | 1558671933
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Entity Type | Individual
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Provider Name | JACLYN KINGMAN M.S.W
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 16412 LOS GATOS BLVD
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City | LOS GATOS
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State | CA
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Zip | 95032-5525
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Country | US
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Telephone | 408-440-0750
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 661482
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City | SACRAMENTO
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State | CA
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Zip | 95866-1482
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Country | US
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Telephone | 408-440-0750
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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 | 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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