Individual
DR. JENNIFER ALICE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
Mailing address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004459
VA
Other
Enumeration date
03/01/2011
Last updated
09/13/2011
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