Provider Demographics
NPI:1548471980
Name:EGGERT, JENNIFER (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:EGGERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5301
Mailing Address - Country:US
Mailing Address - Phone:415-264-0540
Mailing Address - Fax:415-777-1407
Practice Address - Street 1:582 MARKET ST
Practice Address - Street 2:SUITE 2004
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5301
Practice Address - Country:US
Practice Address - Phone:415-264-0540
Practice Address - Fax:415-777-1407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical