Provider Demographics
NPI:1447295332
Name:HAWS-MCALISTER, JENNIE L (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:L
Last Name:HAWS-MCALISTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNIE
Other - Middle Name:
Other - Last Name:MCALISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:356 PROVIDENCE MINE ROAD UNIT A
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2854
Mailing Address - Country:US
Mailing Address - Phone:530-265-3487
Mailing Address - Fax:530-265-4457
Practice Address - Street 1:356 PROVIDENCE MINE RD
Practice Address - Street 2:A
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2979
Practice Address - Country:US
Practice Address - Phone:530-265-3487
Practice Address - Fax:265-265-4457
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14754103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL147543Medicare UPIN
CA0PL147543Medicare ID - Type Unspecified