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NPI Code Detail

MEDICARE: DR. JACQUELINE PHILLIPS PHD

MEDICARE: DR. JACQUELINE PHILLIPS PHD
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
1103G00000XClinical NeuropsychologistPS017778PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10533210001OTHERILDMERC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770670689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE PHILLIPS PHD
Provider Business Mailing Address
First Line : 120 E 2ND ST
Second Line : FL 3
City : ERIE
State : PA
Zip : 16507-1578
Country : US
Telephone Number : 713-500-3500
Fax Number :
Provider Business Practice Location Address
First Line : 6410 FANNIN ST STE 1014
Second Line : ATTN: DIRECTOR OF NEUROPSYCHOLOGY
City : HOUSTON
State : TX
Zip : 77030-5301
Country : US
Telephone Number : 713-486-0503
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 03/04/2016

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