Individual
JENNIFER ANN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3079 HARRISON AVE STE D, SOUTH LAKE TAHOE, CA 96150-7976
(530) 721-2664
Mailing address
3079 HARRISON AVE STE D, SOUTH LAKE TAHOE, CA 96150-7976
(916) 783-5208
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
129874
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/24/2025
Last updated
04/28/2025
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