Provider Demographics
NPI:1780918524
Name:TUCKER, JENNIFER HELEN (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HELEN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:WHITNEY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2140 HUNTINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5824
Mailing Address - Country:US
Mailing Address - Phone:916-941-8430
Mailing Address - Fax:916-941-8622
Practice Address - Street 1:3555 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2005
Practice Address - Country:US
Practice Address - Phone:916-482-2371
Practice Address - Fax:916-941-8622
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist