Provider Demographics
NPI:1831401579
Name:JENNINGS, ALYXANDRA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALYXANDRA
Middle Name:L
Last Name:JENNINGS
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 1:8936 BRIDALSMITH DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9218
Mailing Address - Country:US
Mailing Address - Phone:559-448-7485
Mailing Address - Fax:
Practice Address - Street 1:7650 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-9663
Practice Address - Country:US
Practice Address - Phone:209-662-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic