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General NPI Number Information
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NPI Number | 1134225972
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Entity Type | Organization
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Legal Business Name | JENNIFER VANE, PH.D., P.C.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 4409 MEDICAL PKWY
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City | AUSTIN
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State | TX
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Zip | 78756-3313
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Country | US
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Telephone | 512-495-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 6704 VALBURN DR
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City | AUSTIN
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State | TX
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Zip | 78731-1802
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Country | US
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Telephone | 512-608-4079
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Fax |
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Authorized Official
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Title or Position | PRESIDENT LICENSED PSYCHOLOGIST
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Name | DR. JENNIFER VANE MELROSE
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Credential | PH.D.
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Telephone | 512-495-9556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32530
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License Number State | TX
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