Provider Demographics
NPI:1568737799
Name:KERBY, JESSICA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:KERBY
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 1:7862 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4966
Mailing Address - Country:US
Mailing Address - Phone:269-569-2216
Mailing Address - Fax:
Practice Address - Street 1:7320 GARDEN LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4423
Practice Address - Country:US
Practice Address - Phone:269-612-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015083103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling