| Dr. Edward L Jackson Psyd Pllc | |
|
2900 Welch Rd Commerce Twp MI 48390-1562 | |
| (248) 767-7927 | |
| Not Available |
| Full Name | Dr. Edward L Jackson Psyd Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 2900 Welch Rd, Commerce Twp, Michigan |
| Authorized Official Name and Position | Stephanie Budry (ADMIN) |
| Authorized Official Contact | 2483762406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Edward L Jackson Psyd Pllc 2900 Welch Rd Commerce Twp MI 48390-1562 Ph: (248) 767-7927 | Dr. Edward L Jackson Psyd Pllc 2900 Welch Rd Commerce Twp MI 48390-1562 Ph: (248) 767-7927 |
| NPI Number | 1669156998 |
|---|---|
| Provider Enumeration Date | 06/15/2023 |
| Last Update Date | 10/05/2023 |
| Certification Date | 10/05/2023 |
| Medicare PECOS PAC ID | 2860837580 |
|---|---|
| Medicare Enrollment ID | O20240304001567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669156998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Edward Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043606213 PECOS PAC ID: 3779928494 Enrollment ID: I20240304001745 |
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