Provider Demographics
NPI:1710760210
Name:ROY-POGUTTER, JENNIFER LEANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEANN
Last Name:ROY-POGUTTER
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:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:96020-0170
Mailing Address - Country:US
Mailing Address - Phone:530-250-7718
Mailing Address - Fax:
Practice Address - Street 1:150 MAIN ST SUITE B
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:CA
Practice Address - Zip Code:96020
Practice Address - Country:US
Practice Address - Phone:530-250-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29544103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist