Basic Information
| Provider Information | |||||||||
| NPI: | 1528450459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | CREWS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 WEST LN | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952103377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094763881 | ||||||||
| FaxNumber: | 2094763528 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 WEST LN | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952103377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094763881 | ||||||||
| FaxNumber: | 2094763528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2015 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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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 | 103T00000X | PSY 26767 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.