Provider Demographics
NPI:1487857454
Name:HORN, JACQUELINE B (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:B
Last Name:HORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 I STREET
Mailing Address - Street 2:#5
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4420
Mailing Address - Country:US
Mailing Address - Phone:916-447-8783
Mailing Address - Fax:916-447-1540
Practice Address - Street 1:3010 I STREET
Practice Address - Street 2:#5
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4420
Practice Address - Country:US
Practice Address - Phone:916-447-8783
Practice Address - Fax:916-447-1540
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7218103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL72180Medicare ID - Type Unspecified