Provider Demographics
NPI:1932972635
Name:OLLETT, JERRI DAHLE
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:DAHLE
Last Name:OLLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HASH CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-6117
Mailing Address - Country:US
Mailing Address - Phone:707-292-0317
Mailing Address - Fax:
Practice Address - Street 1:313 HASH CT
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-6117
Practice Address - Country:US
Practice Address - Phone:707-292-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator