Provider Demographics
NPI:1104971456
Name:BALE, JENNIFER ANN (CADC CAS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BALE
Suffix:
Gender:F
Credentials:CADC CAS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3430
Mailing Address - Country:US
Mailing Address - Phone:916-796-0020
Mailing Address - Fax:916-796-0045
Practice Address - Street 1:2100 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5721
Practice Address - Country:US
Practice Address - Phone:916-442-4985
Practice Address - Fax:916-442-1029
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24031214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)