Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003027137 |
---|---|
Provider Name | Jessica Lynn Allen |
First Address | Santa Rosa, CA 95403-3007 |
Second Address | Santa Rosa, CA 95403-3007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 01/12/2011 |