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NPI Code Detail

MEDICARE: MISS JENNIFER SUSAN CHURCHILL

MEDICARE: MISS JENNIFER SUSAN CHURCHILL
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
1101Y00000XCounselorCA
2175T00000XPeer SpecialistJPGCUTBYWRQIXHOSCA

General Provider Information

NPI Number : 1518298330
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER SUSAN CHURCHILL
Provider Business Mailing Address
First Line : 2750 SUTTERVILLE RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-1093
Country : US
Telephone Number : 916-290-8233
Fax Number : 916-388-9273
Provider Business Practice Location Address
First Line : 2750 SUTTERVILLE RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-1093
Country : US
Telephone Number : 916-290-8233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2010
Last Update Date : 04/07/2023

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Directions to “ MISS JENNIFER SUSAN CHURCHILL ” Practice Location

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