Provider Demographics
NPI:1881927424
Name:KRAEMER, JACLYN (PHD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WILLOW ROAD
Mailing Address - Street 2:BUILDING 351
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-617-2686
Practice Address - Street 1:795 WILLOW ROAD
Practice Address - Street 2:BUILDING 351
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2686
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2014-09-17
Deactivation Date:2013-03-06
Deactivation Code:
Reactivation Date:2014-09-17
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA26612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)