Provider Demographics
NPI:1295159945
Name:ZIZZO, JENNIFER SEPULVEDA (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SEPULVEDA
Last Name:ZIZZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W SHAW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2515
Mailing Address - Country:US
Mailing Address - Phone:559-632-0021
Mailing Address - Fax:
Practice Address - Street 1:516 W SHAW AVE STE 200
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2515
Practice Address - Country:US
Practice Address - Phone:559-632-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30364103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty