Provider Demographics
NPI:1326198938
Name:DENSMORE JOHN, JEAN ELLEN (PHD, MS, RD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ELLEN
Last Name:DENSMORE JOHN
Suffix:
Gender:F
Credentials:PHD, MS, RD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:E
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MS, RD
Mailing Address - Street 1:855 ESTRELLA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-2126
Mailing Address - Country:US
Mailing Address - Phone:805-563-2217
Mailing Address - Fax:805-563-2217
Practice Address - Street 1:855 ESTRELLA DR.
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-563-2217
Practice Address - Fax:805-563-2217
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 133N00000X
CAPSY23961103T00000X
WIRD441285133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered