Provider Demographics
NPI:1891968418
Name:FALLMAN, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FALLMAN
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 1:5342 DUDLEY BLVD
Mailing Address - Street 2:MAIL CODE 116
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1012
Mailing Address - Country:US
Mailing Address - Phone:916-561-7461
Mailing Address - Fax:916-561-7471
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:MAIL CODE 116
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7461
Practice Address - Fax:916-561-7461
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2013-10-18
Deactivation Date:2011-02-02
Deactivation Code:
Reactivation Date:2013-10-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker