Provider Demographics
NPI:1295052413
Name:JENNINGS, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 TWIN DOLPHIN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1133
Mailing Address - Country:US
Mailing Address - Phone:650-631-9999
Mailing Address - Fax:650-631-9988
Practice Address - Street 1:1060 TWIN DOLPHIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1133
Practice Address - Country:US
Practice Address - Phone:650-631-9999
Practice Address - Fax:650-631-9988
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst