Provider Demographics
NPI:1124452750
Name:JENNIFER ROY-POGUTTER
Entity type:Organization
Organization Name:JENNIFER ROY-POGUTTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:ROY-POGUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-940-2419
Mailing Address - Street 1:6143 E HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-7981
Mailing Address - Country:US
Mailing Address - Phone:559-940-2419
Mailing Address - Fax:
Practice Address - Street 1:6143 E HAMPTON WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-7981
Practice Address - Country:US
Practice Address - Phone:559-940-2419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNLISCENCED251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management