Provider Demographics
NPI:1336461821
Name:DODD, JENNIFER DEBORAH
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DEBORAH
Last Name:DODD
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 1:414 I ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4217
Mailing Address - Country:US
Mailing Address - Phone:650-703-2597
Mailing Address - Fax:
Practice Address - Street 1:414 I ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4217
Practice Address - Country:US
Practice Address - Phone:650-703-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator