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General NPI Number Information
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NPI Number | 1104766765
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Entity Type | Organization
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Legal Business Name | SISKIYOU PSYCHOLOGY LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 204 W 9TH ST
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City | MEDFORD
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State | OR
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Zip | 97501-3135
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Country | US
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Telephone | 888-556-7282
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Fax | 458-203-5051
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Provider Business Mailing Address
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Address Line | PO BOX 1787
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City | MEDFORD
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State | OR
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Zip | 97501-0261
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Country | US
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Telephone | 888-556-7282
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Fax | 458-203-5051
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MATHEWS
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Credential |
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Telephone | 314-757-4969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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