Individual
DR. JACQUELINE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6410 FANNIN ST STE 1014, ATTN: DIRECTOR OF NEUROPSYCHOLOGY, HOUSTON, TX 77030-5301
(713) 486-0503
Mailing address
120 E 2ND ST, FL 3, ERIE, PA 16507-1578
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS017778
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0533210001
DMERC
IL
05
—
2030728-01
—
TX
Enumeration date
10/10/2006
Last updated
03/04/2016
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