Provider Demographics
NPI:1780807602
Name:ALEXANDER, JENNIFER ANNE (MA PSYCHOLOGY)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ALEXANDER
Other - Last Name:BOND-ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA PSYCHOLOGY
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-1987
Mailing Address - Country:US
Mailing Address - Phone:530-391-9918
Mailing Address - Fax:530-626-2589
Practice Address - Street 1:4250 FOWLER LN
Practice Address - Street 2:SUITE #204
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9781
Practice Address - Country:US
Practice Address - Phone:530-391-9918
Practice Address - Fax:530-626-2589
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist