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General NPI Number Information
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NPI Number | 1649912528
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Entity Type | Individual
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Provider Name | JACQOULENE HANSBERGER PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/20/2025
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Provider Practice Location Address
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Address Line | 7055 W BELL RD STE B5
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City | GLENDALE
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State | AZ
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Zip | 85308-8544
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Country | US
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Telephone | 602-818-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 8607 N 59TH AVE STE C6
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City | GLENDALE
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State | AZ
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Zip | 85302-5435
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Country | US
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Telephone | 602-818-4775
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-005877
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License Number State | AZ
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