MEDICARE: DR. EMILY RUTH JERNBERG 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
1	103TC0700X	Clinical Psychologist	6301008691	MI

General Provider Information

NPI Number	:	1871590117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY RUTH JERNBERG PH. D.

Provider Business Mailing Address
First Line	:	1460 WALTON BLVD
Second Line	:	#202
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1768
Country	:	US
Telephone Number	:	248-505-4161
Fax Number	:	248-601-9991

Provider Business Practice Location Address
First Line	:	1460 WALTON BLVD
Second Line	:	#202
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1768
Country	:	US
Telephone Number	:	248-505-4161
Fax Number	:	248-601-9991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	05/08/2012

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