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NPI Code Detail

MEDICARE: DR. KRISTEN B JACKSON PH.D.

MEDICARE: DR. KRISTEN B JACKSON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TR0400XRehabilitation Psychologist

General Provider Information

NPI Number : 1164760500
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTEN B JACKSON PH.D.
Provider Business Mailing Address
First Line : 480 MEDICAL CENTER DR
Second Line : DODD HALL 2145
City : COLUMBUS
State : OH
Zip : 43210-1229
Country : US
Telephone Number : 614-293-3830
Fax Number : 614-293-4870
Provider Business Practice Location Address
First Line : 480 MEDICAL CENTER DR
Second Line : DODD HALL 2145
City : COLUMBUS
State : OH
Zip : 43210-1229
Country : US
Telephone Number : 614-293-3830
Fax Number : 614-293-4870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2013
Last Update Date : 01/18/2013

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