Provider Demographics
NPI:1548441835
Name:CANU, JENNIFER ROSS
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSS
Last Name:CANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSS
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:10090 HIGHWAY 9 STE 6
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9251
Mailing Address - Country:US
Mailing Address - Phone:831-204-0219
Mailing Address - Fax:
Practice Address - Street 1:10090 HIGHWAY 9 STE 6
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9251
Practice Address - Country:US
Practice Address - Phone:831-204-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist