Provider Demographics
NPI:1336269687
Name:WILLIS, JENNIFER M (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 SOLOMON ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5930
Mailing Address - Country:US
Mailing Address - Phone:916-374-9610
Mailing Address - Fax:
Practice Address - Street 1:1815 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6636
Practice Address - Country:US
Practice Address - Phone:916-492-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor