Provider Demographics
NPI:1396026472
Name:PEASE, JACLYN BROOKE (PSYD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:BROOKE
Last Name:PEASE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3257
Mailing Address - Country:US
Mailing Address - Phone:760-889-1746
Mailing Address - Fax:
Practice Address - Street 1:2701 COTTAGE WAY STE 16
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1226
Practice Address - Country:US
Practice Address - Phone:916-407-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29768103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist