Provider Demographics
NPI:1558564328
Name:DOBNER, JENNIFER ROTH
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROTH
Last Name:DOBNER
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:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:RIVER PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95675-0011
Mailing Address - Country:US
Mailing Address - Phone:530-391-6633
Mailing Address - Fax:
Practice Address - Street 1:344 PLACERVILLE DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3920
Practice Address - Country:US
Practice Address - Phone:530-391-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health