Provider Demographics
NPI:1033217047
Name:JENNETT, JEAN ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANN
Last Name:JENNETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 VIA DEL ORO
Mailing Address - Street 2:#225
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:408-281-2252
Mailing Address - Fax:408-365-9488
Practice Address - Street 1:6840 VIA DEL ORO
Practice Address - Street 2:#225
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-281-2252
Practice Address - Fax:408-365-9488
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL106280Medicare ID - Type Unspecified