Provider Demographics
NPI:1487803342
Name:JENNEN, RICHARD DEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
Last Name:JENNEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:2450 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6526
Mailing Address - Country:US
Mailing Address - Phone:520-352-9955
Mailing Address - Fax:520-352-9960
Practice Address - Street 1:7461 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3477
Practice Address - Country:US
Practice Address - Phone:520-352-9955
Practice Address - Fax:520-352-9960
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3988103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist