Individual
DR. JEAN S CANNON
Active
Individual
DR. JEAN S CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS015850
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101535870-0001
—
PA
01
—
CA1850139
HIGHMARK BLUE SHIEL
—
Enumeration date
05/05/2006
Last updated
03/17/2011
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