Basic Information
| Provider Information | |||||||||
| NPI: | 1013316017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANT-WING | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | FAITH | ||||||||
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| Credential: | B.C.B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3995 MARCOLA RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974777948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417261465 | ||||||||
| FaxNumber: | 5417265085 | ||||||||
| Practice Location | |||||||||
| Address1: | 7839 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919420476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518134034 | ||||||||
| FaxNumber: | 9518134035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2014 | ||||||||
| LastUpdateDate: | 07/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0146013 | CA | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-16-21381 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.