Provider Demographics
NPI:1093903932
Name:BROOKMAN, JENNIFER SUZANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:BROOKMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:RODWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:249 ILENE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2226
Mailing Address - Country:US
Mailing Address - Phone:650-477-4886
Mailing Address - Fax:
Practice Address - Street 1:249 ILENE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2226
Practice Address - Country:US
Practice Address - Phone:925-854-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist