Basic Information
| Provider Information | |||||||||
| NPI: | 1245624832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLENDEBROEK | ||||||||
| FirstName: | JODY | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 BARNER AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946023414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073159462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2560 9TH STREET SUITE 220A | ||||||||
| Address2: | STE CONSULTANTS LLC | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106659700 | ||||||||
| FaxNumber: | 5106659400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2015 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-9974 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.