Provider Demographics
NPI:1467550996
Name:WATSON, JENNIFER SAXON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SAXON
Last Name:WATSON
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 1:23624 DEL CERRO CIR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5335
Mailing Address - Country:US
Mailing Address - Phone:818-317-3421
Mailing Address - Fax:818-337-2956
Practice Address - Street 1:21731 VENTURA BLVD STE 160
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5109
Practice Address - Country:US
Practice Address - Phone:818-317-3421
Practice Address - Fax:818-337-2956
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY-9618103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9618BOtherMEDICARE
CACP9618BOtherMEDICARE PTAN
CACP9618BOtherMEDICARE
CACP9618BOtherMEDICARE PTAN