Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 23352 | TX |
NPI | 1043370570 |
---|---|
Provider Name | Dr. Susan R Jennings |
First Address | San Antonio, TX 78257-1159 |
Second Address | San Antonio, TX 78257-1159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00DX59 | (02) | TX |
00DX59 | (05) | TX |