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NPI Code Detail

MEDICARE: KORIN ALEXANDRIA JACKS

MEDICARE: KORIN ALEXANDRIA JACKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist240149552CA

General Provider Information

NPI Number : 1568393577
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORIN ALEXANDRIA JACKS
Provider Business Mailing Address
First Line : 20737 ROSCOE BLVD UNIT 804
Second Line :
City : WINNETKA
State : CA
Zip : 91306-1766
Country : US
Telephone Number : 909-285-8534
Fax Number :
Provider Business Practice Location Address
First Line : 4111 LAS VIRGENES RD
Second Line :
City : CALABASAS
State : CA
Zip : 91302-1886
Country : US
Telephone Number : 818-880-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ KORIN ALEXANDRIA JACKS ” Practice Location

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