Provider Demographics
NPI:1992083711
Name:KHAW, JENNIFER REBECCA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:KHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 WILLOW PASS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2414
Mailing Address - Country:US
Mailing Address - Phone:925-692-0090
Mailing Address - Fax:925-692-0091
Practice Address - Street 1:2118 WILLOW PASS RD STE 500
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2414
Practice Address - Country:US
Practice Address - Phone:925-692-0090
Practice Address - Fax:925-692-0091
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist