Provider Demographics
NPI:1093466302
Name:RUMMERFIELD, JEREMY DAVID SR (SUDRC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:RUMMERFIELD
Suffix:SR
Gender:M
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W OAK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4929
Mailing Address - Country:US
Mailing Address - Phone:559-732-4885
Mailing Address - Fax:559-732-8289
Practice Address - Street 1:1731 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6232
Practice Address - Country:US
Practice Address - Phone:559-732-4885
Practice Address - Fax:559-732-8289
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)