Individual
JESSICA LYNN HACKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2121 LAKE AVE, 116A-M, FORT WAYNE, IN 46805-5100
(765) 674-3321
Mailing address
53931 WILBUR RD, THREE RIVERS, MI 49093-9765
(812) 841-1448
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6646
OH
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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