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General NPI Number Information
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NPI Number | 1639062458
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Entity Type | Individual
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Provider Name | BRIGEE JANNESE JACKSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1212 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95202-1552
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Country | US
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Telephone | 209-468-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 PARKSIDE DR STE 200
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City | CONCORD
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State | CA
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Zip | 94519-2525
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Country | US
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Telephone | 510-318-2671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34274
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License Number State | CA
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