Individual
JENNA TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3505 BROADWAY, OAKLAND, CA 94611-5714
(510) 752-6298
Mailing address
3505 BROADWAY, OAKLAND, CA 94611-5714
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
GC000665
CA
Other
Enumeration date
07/24/2016
Last updated
01/03/2022
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