Healthcare Provider Details

I. General information

NPI: 1174440317
Provider Name (Legal Business Name): KOERNER PSYCHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 EL CAJON BLVD STE N-109
LA MESA CA
91942-6719
US

IV. Provider business mailing address

7918 EL CAJON BLVD STE N-109
LA MESA CA
91942-6719
US

V. Phone/Fax

Practice location:
  • Phone: 619-683-4981
  • Fax:
Mailing address:
  • Phone: 619-683-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SARAH KOERNER-JORDAN
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 619-683-4981