Basic Information
| Provider Information | |||||||||
| NPI: | 1427185685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JOANNA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NOUD | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | JOANNA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1202 MORENA BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192750822 | ||||||||
| FaxNumber: | 6192751422 | ||||||||
| Practice Location | |||||||||
| Address1: | 10717 CAMINO RUIZ | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921263264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586952211 | ||||||||
| FaxNumber: | 8586953521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/27/2013 | ||||||||
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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 | 106H00000X | 43745 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.