Provider Demographics
NPI:1033494406
Name:ELSTER, JACQUELINE RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RENEE
Last Name:ELSTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24007 MERRILYN CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2333
Mailing Address - Country:US
Mailing Address - Phone:317-678-7423
Mailing Address - Fax:317-204-8787
Practice Address - Street 1:24007 MERRILYN CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2333
Practice Address - Country:US
Practice Address - Phone:317-678-7423
Practice Address - Fax:317-204-8787
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042859A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical