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General NPI Number Information
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NPI Number | 1669156998
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Entity Type | Organization
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Legal Business Name | DR. EDWARD L JACKSON PSYD PLLC
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 2900 WELCH RD
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City | COMMERCE TWP
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State | MI
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Zip | 48390-1562
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Country | US
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Telephone | 248-767-7927
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 WELCH RD
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City | COMMERCE TWP
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State | MI
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Zip | 48390-1562
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Country | US
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Telephone | 248-767-7927
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | STEPHANIE BUDRY
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Credential |
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Telephone | 248-376-2406
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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 |
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License Number State |
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