Provider Demographics
NPI:1407412620
Name:SISLER, JENNY LEE
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:SISLER
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 1:2280 DIAMOND BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5719
Mailing Address - Country:US
Mailing Address - Phone:925-503-7240
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE C5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3631
Practice Address - Country:US
Practice Address - Phone:925-768-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health