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NPI Code Detail

MEDICARE: DR. JACLYN MICHELLE DAVIS PH.D.

MEDICARE: DR. JACLYN MICHELLE DAVIS 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
1103TC0700XClinical Psychologist38202TX
2103T00000XPsychologistPS017996PA

General Provider Information

NPI Number : 1477833176
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACLYN MICHELLE DAVIS PH.D.
Provider Business Mailing Address
First Line : 1045 S CEDAR CREST BLVD
Second Line :
City : ALLENTOWN
State : PA
Zip : 18103-5443
Country : US
Telephone Number : 610-433-3360
Fax Number :
Provider Business Practice Location Address
First Line : 1515 S CAPITAL OF TEXAS HWY STE 200
Second Line :
City : AUSTIN
State : TX
Zip : 78746-6544
Country : US
Telephone Number : 512-649-1742
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2011
Last Update Date : 02/18/2020

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