Provider Demographics
NPI:1588043202
Name:ALLDREDGE, JENNIFER (IMF)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALLDREDGE
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PARENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-690-2536
Mailing Address - Fax:530-528-8034
Practice Address - Street 1:590 ANTELOPE BLVD STE 20
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2474
Practice Address - Country:US
Practice Address - Phone:530-690-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF65899106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist