Provider Demographics
NPI:1336655919
Name:ALLEN-WHITE, JERI YVONNE
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:YVONNE
Last Name:ALLEN-WHITE
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 1:9384 BOWMONT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6549
Mailing Address - Country:US
Mailing Address - Phone:209-327-5665
Mailing Address - Fax:
Practice Address - Street 1:600 BERCUT DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0131
Practice Address - Country:US
Practice Address - Phone:916-440-1500
Practice Address - Fax:916-440-1514
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAP6536101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program