Basic Information
| Provider Information | |||||||||
| NPI: | 1881831899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONGDON | ||||||||
| FirstName: | JACLYN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 VIA CANDIDIZ | ||||||||
| Address2: | UNIT 126 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921303156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212875977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2009 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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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 | 106H00000X | IMF 74969 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.