Provider Demographics
NPI:1275772907
Name:JARVIS, JOHN B (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:JARVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 4TH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3661
Mailing Address - Country:US
Mailing Address - Phone:707-523-7025
Mailing Address - Fax:707-523-3024
Practice Address - Street 1:1701 4TH ST
Practice Address - Street 2:STE 120
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3661
Practice Address - Country:US
Practice Address - Phone:707-523-7025
Practice Address - Fax:707-523-3024
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU458231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist