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General NPI Number Information
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NPI Number | 1912632365
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Entity Type | Individual
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Provider Name | DR. JILL JANSSEN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 3400 STRATFORD RD NE APT 1001
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City | ATLANTA
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State | GA
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Zip | 30326-1702
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Country | US
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Telephone | 478-206-4498
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 STRATFORD RD NE APT 1001
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City | ATLANTA
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State | GA
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Zip | 30326-1702
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Country | US
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Telephone | 478-206-4498
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 393384
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License Number State | GA
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