Provider Demographics
NPI:1518323831
Name:JAYNE, SHILOH MARIE
Entity type:Individual
Prefix:MRS
First Name:SHILOH
Middle Name:MARIE
Last Name:JAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHILOH
Other - Middle Name:MARIE
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2235 CHALLENGER WAY
Mailing Address - Street 2:101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407
Mailing Address - Country:US
Mailing Address - Phone:707-565-3014
Mailing Address - Fax:
Practice Address - Street 1:2235 CHALLENGER WAY
Practice Address - Street 2:101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407
Practice Address - Country:US
Practice Address - Phone:707-565-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist