Provider Demographics
NPI:1164826673
Name:SHLACHTER, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SHLACHTER
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 1:12242 BUSINESS PARK DR STE 19
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-3327
Mailing Address - Country:US
Mailing Address - Phone:530-536-0959
Mailing Address - Fax:
Practice Address - Street 1:12242 BUSINESS PARK DR STE 19
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-3327
Practice Address - Country:US
Practice Address - Phone:530-536-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical