Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1285930040 |
---|---|
Provider Name | Ms. Jennifer Marie Langenheim |
First Address | Merced, CA 95348-3028 |
Second Address | Merced, CA 95341-6211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 10/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285930040 | (05) | CA |