Provider Demographics
NPI:1316455926
Name:NICHOLS, JENNY ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:ELIZABETH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:E
Other - Last Name:IMBERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1660 E ROSEVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3988
Mailing Address - Country:US
Mailing Address - Phone:167-844-0009
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:1660 E ROSEVILLE PKWY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3988
Practice Address - Country:US
Practice Address - Phone:167-844-0009
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical