Provider Demographics
NPI:1811267115
Name:GILDNER, JENNIFER L (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:GILDNER
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:ONE SHIELDS AVENUE
Mailing Address - Street 2:CAPS - UNIVERSITY OF CALIFORNIA, DAVIS
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-752-0871
Mailing Address - Fax:
Practice Address - Street 1:ONE SHIELDS AVENUE
Practice Address - Street 2:219 NORTH HALL, UC DAVIS
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-752-0871
Practice Address - Fax:530-752-9923
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5268103TC1900X
CAPSY24958103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling