Provider Demographics
NPI:1376184176
Name:MENARD, JENNA ROSE (MA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:MENARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 EXECUTIVE WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0634
Mailing Address - Country:US
Mailing Address - Phone:530-921-2685
Mailing Address - Fax:
Practice Address - Street 1:930 EXECUTIVE WAY STE 125
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0634
Practice Address - Country:US
Practice Address - Phone:530-921-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist