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NPI Code Detail

MEDICARE: DR. JENNIFER LEE ROUSCH PSYD

MEDICARE:  DR. JENNIFER LEE ROUSCH  PSYD
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
1103T00000XPsychologistPSY20251CA

General Provider Information

NPI Number : 1366749699
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER LEE ROUSCH PSYD
Provider Business Mailing Address
First Line : 5500 E ATHERTON ST STE 310
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-4022
Country : US
Telephone Number : 818-398-2934
Fax Number :
Provider Business Practice Location Address
First Line : 5500 E ATHERTON ST STE 310
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-4022
Country : US
Telephone Number : 818-398-2934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2011
Last Update Date : 02/23/2011

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