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General NPI Number Information
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NPI Number | 1689907347
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Entity Type | Individual
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Provider Name | JENNA MARIE MCADAM MS, RAS, MFTI
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Gender | Female
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1481 POST RANCH RD
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City | SANTA ROSA
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State | CA
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Zip | 95405-7568
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Country | US
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Telephone | 707-327-8258
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Fax | 707-526-3250
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Provider Business Mailing Address
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Address Line | 1481 POST RANCH RD
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City | SANTA ROSA
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State | CA
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Zip | 95405-7568
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Country | US
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Telephone | 707-327-8258
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Fax | 707-526-3250
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF90108
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License Number State | CA
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