Active NPI
Jaclyn Brooke Pease, PSY.D.
- Psychologist
- Sacramento, CA
National Provider Identifier
1396026472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY29768
- Practice address
- 2701 Cottage Way Ste 16
Sacramento, CA 95825-1226 - Phone
- (916) 407-4943
- NPI assigned
- Sep 2, 2011
- Last updated
- Jul 29, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY29768 | CA | Primary |
Addresses
Primary practice location
2701 Cottage Way Ste 16
Sacramento, CA 95825-1226
Mailing address
8801 Folsom Blvd
Sacramento, CA 95826-3257
Phone (760) 889-1746
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY29768 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1396026472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8801 FOLSOM BLVD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958263257",
"telephone_number": "760-889-1746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 COTTAGE WAY STE 16",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958251226",
"telephone_number": "916-407-4943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEASE",
"first_name": "JACLYN",
"middle_name": "BROOKE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-02",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY29768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.