Provider Demographics
NPI:1235631581
Name:RICKARDS, JENNIFER MEGHAN I
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MEGHAN
Last Name:RICKARDS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 JAMACHA RD STE 501
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4366
Mailing Address - Country:US
Mailing Address - Phone:619-274-8140
Mailing Address - Fax:
Practice Address - Street 1:2514 JAMACHA RD STE 501
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4366
Practice Address - Country:US
Practice Address - Phone:619-274-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA10765237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician