Provider Demographics
NPI:1164562757
Name:KIEFER, JAQUELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAQUELINE
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 N HIGHWAY 101
Mailing Address - Street 2:STE 16
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1180
Mailing Address - Country:US
Mailing Address - Phone:858-692-7892
Mailing Address - Fax:
Practice Address - Street 1:243 N HIGHWAY 101
Practice Address - Street 2:STE 16
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1180
Practice Address - Country:US
Practice Address - Phone:858-692-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19204103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent