Provider Demographics
NPI:1568529808
Name:GUZMAN, JENNIE VINYARD (MPA)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:VINYARD
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:PROF
Other - First Name:JENNIE
Other - Middle Name:ROXBERG
Other - Last Name:VINYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:POTTER VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95469-0041
Mailing Address - Country:US
Mailing Address - Phone:707-743-2912
Mailing Address - Fax:707-743-2912
Practice Address - Street 1:11350 BURRIS LN
Practice Address - Street 2:
Practice Address - City:POTTER VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95469-9784
Practice Address - Country:US
Practice Address - Phone:707-743-2912
Practice Address - Fax:707-743-2912
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health