Provider Demographics
NPI:1215508528
Name:JACKSON, DALONNA TRENAE
Entity type:Individual
Prefix:
First Name:DALONNA
Middle Name:TRENAE
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 EAST BAYSHORE ROAD PO BOX 51083
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-5700
Mailing Address - Country:US
Mailing Address - Phone:650-276-9953
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCHILL AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1099
Practice Address - Country:US
Practice Address - Phone:650-329-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
CA13146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health