Provider Demographics
NPI:1871525329
Name:ANDERSON, JENETTA
Entity type:Individual
Prefix:
First Name:JENETTA
Middle Name:
Last Name:ANDERSON
Suffix:
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 1:260 MAIN ST
Mailing Address - Street 2:STE F
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1778
Mailing Address - Country:US
Mailing Address - Phone:650-366-2900
Mailing Address - Fax:650-366-2908
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:BLDG B
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-423-6322
Practice Address - Fax:831-423-6325
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4104237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist