| Jennifer Blum Psyd Licensed Psychologist Pc | |
|
1144 Sonoma Ave Ste 104 Santa Rosa CA 95405-4812 | |
| (707) 331-4769 | |
| Not Available |
| Full Name | Jennifer Blum Psyd Licensed Psychologist Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1144 Sonoma Ave Ste 104, Santa Rosa, California |
| Authorized Official Name and Position | Jennifer Blum (OWNER) |
| Authorized Official Contact | 7073314769 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Blum Psyd Licensed Psychologist Pc 484 Cornish Ln Angwin CA 94508-9736 Ph: (707) 331-4769 | Jennifer Blum Psyd Licensed Psychologist Pc 1144 Sonoma Ave Ste 104 Santa Rosa CA 95405-4812 Ph: (707) 331-4769 |
| NPI Number | 1639543390 |
|---|---|
| Provider Enumeration Date | 11/18/2015 |
| Last Update Date | 11/18/2015 |
| Medicare PECOS PAC ID | 5991005324 |
|---|---|
| Medicare Enrollment ID | O20151207002942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639543390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 27164 (California) | Primary |
| Provider Name | Jennifer E. Blum |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366820474 PECOS PAC ID: 6800196239 Enrollment ID: I20151230002702 |
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