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NPI Code Detail

MEDICARE: MRS. JENNIFER DELL LINGAFELDT MFT

MEDICARE: MRS. JENNIFER DELL LINGAFELDT MFT
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
1106H00000XMarriage & Family TherapistMFC 40876CA

General Provider Information

NPI Number : 1538211305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER DELL LINGAFELDT MFT
Provider Business Mailing Address
First Line : PO BOX 2796
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-0279
Country : US
Telephone Number : 707-425-5744
Fax Number : 707-425-5162
Provider Business Practice Location Address
First Line : 801 EMPIRE ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-5702
Country : US
Telephone Number : 707-425-5744
Fax Number : 707-425-5162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/08/2007

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