Provider Demographics
NPI:1053306605
Name:STANKIEWICZ, JACKIE LYNN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:LYNN
Last Name:STANKIEWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:JACKIE
Other - Middle Name:LYNN
Other - Last Name:SCHIMMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5550 FRANKLIN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2129
Mailing Address - Country:US
Mailing Address - Phone:615-373-0033
Mailing Address - Fax:615-373-0073
Practice Address - Street 1:5550 FRANKLIN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2129
Practice Address - Country:US
Practice Address - Phone:615-373-0033
Practice Address - Fax:615-373-0073
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2899179Medicaid