Organization
JACQUELINE J HEAD PSYD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE JEAN HEAD PSYD (PRESIDENT)
(503) 625-2768
Entity
Organization
Contact information
Practice address
22344 SW MAIN ST, SHERWOOD, OR 97140-9416
(503) 625-2768
(503) 625-3768
Mailing address
22344 SW MAIN ST, SHERWOOD, OR 97140-9416
(503) 625-2768
(503) 625-3768
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1328
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639153125
NPI, FOR IND. PROVIDER
OR
Enumeration date
07/17/2006
Last updated
08/22/2020
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