Provider Demographics
NPI:1689907347
Name:MCADAM, JENNA MARIE (MS, RAS, MFTI)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MARIE
Last Name:MCADAM
Suffix:
Gender:F
Credentials:MS, RAS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 POST RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7568
Mailing Address - Country:US
Mailing Address - Phone:707-327-8258
Mailing Address - Fax:707-526-3250
Practice Address - Street 1:1481 POST RANCH RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7568
Practice Address - Country:US
Practice Address - Phone:707-327-8258
Practice Address - Fax:707-526-3250
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist