| Jacqueline J Head Psyd Pc | |
|
22344 Sw Main St Sherwood OR 97140-9416 | |
| (503) 625-2768 | |
| (503) 625-3768 |
| Full Name | Jacqueline J Head Psyd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 22344 Sw Main St, Sherwood, Oregon |
| Authorized Official Name and Position | Jacqueline Jean Head (PRESIDENT) |
| Authorized Official Contact | 5036252768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline J Head Psyd Pc 22344 Sw Main St Sherwood OR 97140-9416 Ph: (503) 625-2768 | Jacqueline J Head Psyd Pc 22344 Sw Main St Sherwood OR 97140-9416 Ph: (503) 625-2768 |
| NPI Number | 1528086055 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3971557117 |
|---|---|
| Medicare Enrollment ID | O20050310000056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528086055 | NPI | - | NPPES |
| 1639153125 | Other | OR | NPI, FOR IND. PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1328 (Oregon) | Primary |
| Provider Name | Jacqueline J Head |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639153125 PECOS PAC ID: 6507810744 Enrollment ID: I20050311000150 |
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