Provider Information for 1457860694
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JENNIFER LEE JAECKEL LICSW
Sex: Female
NPI: 1457860694
Last Updated: 2019-06-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1457860694 | ||||||||
| Enumeration Date | 2017-09-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2929 E THOMAS RD PHOENIX, AZ 85016-8034 United States Phone: 602-470-5000 | Fax:602-470-5064 | ||||||||
| Primary Practice Address | 3141 N 3RD AVE PHOENIX, AZ 85013-4360 United States Phone: 602-914-1520 | Fax:602-266-0545 | ||||||||
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