Physician Compare National (NPI:1033301643)

HEALTHCARE PROVIDER: JEN E TELLIER PSYD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1033301643
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789962366
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161102001578
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TELLIER
	Individual professional last name
Provider First Name	JEN
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1815 CLEMENT AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SPC 25
	Group Practice or individual's line 2 address
City	ALAMEDA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	945011375
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5104694132
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y