Provider Demographics
NPI:1942219910
Name:KENNELLY, JENNIFER JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOY
Last Name:KENNELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2571 CALIFORNIA PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-899-1005
Mailing Address - Fax:530-899-1005
Practice Address - Street 1:2571 CALIFORNIA PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-899-1005
Practice Address - Fax:530-899-1005
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q62351Medicare UPIN