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NPI Code Detail

MEDICARE: DR. BECKY LEE JANDREY PH.D.

MEDICARE: DR. BECKY LEE JANDREY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY16691CA

General Provider Information

NPI Number : 1144242041
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BECKY LEE JANDREY PH.D.
Provider Business Mailing Address
First Line : 825 COLLEGE AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4108
Country : US
Telephone Number : 707-570-2377
Fax Number :
Provider Business Practice Location Address
First Line : 825 COLLEGE AVE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4108
Country : US
Telephone Number : 707-570-2377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2006
Last Update Date : 07/08/2007

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