Provider Demographics
NPI:1033382221
Name:SPILLER, JENNELL ANTOINETTE
Entity Type:Individual
Prefix:
First Name:JENNELL
Middle Name:ANTOINETTE
Last Name:SPILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2625
Mailing Address - Country:US
Mailing Address - Phone:209-948-2199
Mailing Address - Fax:209-460-0428
Practice Address - Street 1:322 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2625
Practice Address - Country:US
Practice Address - Phone:209-948-2199
Practice Address - Fax:209-460-0428
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)